目的 探讨腹腔镜手术治疗肥胖患者早期子宫内膜癌的可行性及临床效果.方法 2003年8月~2009年10月采用腹腔镜辅助下经阴道子宫切除术治疗17例体重指数≥30的Ⅰ期子宫内膜癌,对于临床分期Ⅰ B、Ⅰ C期患者同时淋巴结取样.结果 手术时间(215±50)min,术中出血量(231±88) ml,肠功能恢复时间(40±10)h,术后住院(8.2±1.1)d.术中1例损伤膀胱,1例损伤肠道,经镜下修补处理后未引起临床后果;1例因合并糖尿病手术穿刺口部位术后1周出现脂肪液化;1例腹壁穿刺孔出现皮下淤血,经过延长换药时间及微波物理治疗后好转.16例随访3年存活,1例术后13个月阴道残端复发次年死于全身转移.结论 在一定腹腔镜基本技能基础上,肥胖患者早期子宫内膜癌不再是腹腔镜手术的相对禁忌证.%Objective To investigate the feasibility and efficacy of laparoscopic-assisted vaginal hysterectomy for obese patients with stage Ⅰ endometrial cancer. Methods From August 2003 to October 2009, we performed laparoscopic-assisted vaginal hysterectomy on 17 patients with stage Ⅰ endometrial cancer ( lymph nodes sampling was performed on stage Ⅰ s and Ⅰ c patients). All the patients had a BMI ≥ 30. Results The operation was completed in a mean of (215 ±50) min with a mean blood loss of (231 ± 88) ml. The patients had the enterokinesia recovered in (40 ± 10) h, and was discharged from hospital in (8.2 ± 1.1 ) d. During the operation, injury to the bladder occurred in one patient, and injury to the intestine in the another, both the cases were cured by laparoscopic repair. One patient who had diabetes showed fat liquefaction around the puncture site in 1 week after the procedure, and another patient developed ecchymosis at the puncture area, both the patients were improved after changing dressing and physiotherapy with microwave. The patients received a follow-up for 3 years; 16 of them survived uring the period; one patient showed recurrence at the vaginal stump at 13 months postoperation, and died of systemic metastasis in the next year. Conclusions Obese is no longer a contraindication for laparoscopic-assisted vaginal hysterectomy for patients with stage Ⅰ endometrial cancer.
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