Analysis On The Treatment Of Laparoscopic And Laparotomy For Early Cervical Cancer

Objective: To analysis the treatment outcome,pathological results and the main postoperative complications for early cervical cancer with laparoscopy in recent years through the retrospective study,for the better development of laparoscopic surgery in the early cervical cancer in the future.Methods: There were 721 cases of cervical cancer admitted in our department in total in four years between 2013.01.01 ~ 2016.12.31,using theelectronic case management system.Pathological patterns can be acquired in 684 cases in total.We have performed 659 radical surgerys for cervical cancer,in which 246 through laparoscopic surgery and 413 abdominal.There are 209 pathological types acquired in laparoscopic,222 performed lymphadenectomy,whith can be acquired the postoperative pathology including the number of lumph nodes.In abdominal there were 334 acquired the postoperative pathology.Statisticis the patient,s age,pathological patterns,postoperative pathological types,the number of lumph nodes and conditions,complications of intraoperative and postoperative.Results: The average age of 721 cases was 49.27±9.41,range from 25 to 83.The distribution of 684 pathological types were squamous cell carcinoma 587 cases(85.82%),adenocarcinoma 62 cases(9.06%),adenosquamous carcinoma 19 cases(2.78%),neuroendocrine type 8 cases(1.17%),Chorionic tubular adenocarcinoma 5 cases(0.73%),endometrioid adenocarcinoma 1 case(0.15%),clear cell carcinoma 2 cases(0.29%).2009 FIGO staging IB1 have 265 in 721 cases(36.75%),2009 FIGO stagingIB1 have 118 cases in 246 laparoscopic group(47.97%).The average age of 246 cases performed laparoscopic was 26~74,range from 26 to 74 years old.The distribution of 246 pathological types acquired were squamous cell carcinoma 205 cases(83.33%),adenocarcinoma 24 cases(9.76%),adenosquamous carcinoma 10 cases(4.06%),neuroendocrine type 2 cases(0.81%),Chorionic tubular adenocarcinoma 4 cases 3(1.22%),clear cell carcinoma 2 cases(0.81%).The average of lumph nodes acquired in 222 cases was 26.05±7.08,range from 6 to 54,lymph nodes metastasis rate was 51/222(22.97%).The average of metastasis lumph nodes was 3.08±3.17,range from 1 to 17.LVSI(+)count for 82/222(36.93%),depth of myometrial invasion >1/2 133/222(59.90%).Traditional radical hysterectomy have 413 cases in all.The average of lumph nodes acquired in 334 cases was 25.97±7.95,range from 11 to 57,lymph nodes metastasis rate was 70/334(20.96%).The average of metastasis lumph nodes was 3.76±4.35,range from 1 to 24.556 cases can be acquired postoperative histopathology in radical hysterectomy.The average of lumph nodes was 26.05±7.79,lymph nodes metastasis rate was 121/556(21.76%).FIGO staging 1B1 combined metastasis of lumph nodes have rate of 44/242(18.18%),staging 1B2 combined metastasis of lumph nodes have rate of 15/56(26.79%),staging IIA1 combined metastasis of lumph nodes have rate of 39/137(28.46%),staging IIA2 combined metastasis of lumph nodes have rate of 23/74(31.08%).Laparoscopic cervical cancer percentage accounted for the annual total number of cervical cancer four years as follow shows.2013~2014 accounted for 19/155(12.26%),2014~2015 accounted for 41/166(24.70%),2015~2016 accounted for 75/146(51.37%),2016~2017 accounted for 111/192(57.81%).Laparoscopic cervical cancer accounted for 246/659(37.33%)in all.Laparoscopic cervical cancer(Piver type II or type III)+ pelvic lymphadenoetomyhave 219 cases,53 cases(24.20%)performed ovarian preserving,years range form 26~47 in patients.The incidence of ureter and bladder fistula count for 14/640(2.19%)inall,Laparoscopic count for 6/227((2.64%)),abdominal count for 8/413(1.94%).Rate of blood transfusion in laparoscopic count for 15/246(6.10%)and abdominal count for 175/413(42.37%).Intestinal obstruction count for 3/246(1.22%),Lymphatic cyst infection count for 2/246(0.81%),subcutaneous emphysema count for 2/246(0.81%),conversion to laparotomy count for 5/246(2.03%).Conclusion: Patients with cervical cancer have rised in four years generally.The proportion of laparoscopic cervical cancer growed gradually by years.Patients with cervical cancer distributed normally,peaking age was 50 years old.Squamous cell carcinoma account for the most part of pathological types,and far above the database in abord.Laparoscopic cleaning the number of lymph nodes and lymph node metastasis number with no difference between the open group.Laparoscopic ovarian perservationg is higher,LVSI(+)and depth of myometrial invasion >1/2 have tight association with metastasis of lumph nodes.FIGO IB1 acount for the most part of all staging.With the increase of focal diameter and tumor stage rising,the risk of lymph node metastasis also increased.The overall rate of urinary tract injury in cervical cancer radical was in permitted range.Laparoscopic group slightly higher than the open group form the aspect of urinary tract damage.Laparoscopic intraoperative blood transfusion rate is lower.