目的 探究机器人宫颈癌根治术用于放化疗后局部晚期宫颈癌的安全性和可行性.方法 选取2013年3月至2015年6月在西京医院接受机器人宫颈癌根治术的101例FIGO分期为ⅠB2~ⅡB期的宫颈癌患者的临床资料.根据术前放化疗与否,将纳入病例分为两组:术前接受过同步放化疗的51例宫颈癌患者为观察组;术前未接受过辅助治疗的50例宫颈癌患者为对照组.两组患者均行机器人宫颈癌根治术.分析比较两组患者的手术时间、术中出血量、术后住院天数、术中术后并发症、术后病理资料和术后补充放化疗及复发生存等情况.统计分析观察组术前放化疗的临床疗效.结果 两组患者在年龄、BMI方面、盆腔手术史和病理分期方面,差别无统计学意义(t值分别为-0.48、0.44,χ2值分别为0.01、4.20;均P>0.05).观察组术中清扫的淋巴结个数较对照组少,差别有统计学意义(Z=-4.04,P<0.001).两组的平均手术时间、平均术中出血量、平均术后住院时间、平均术后最高体温、平均术后通气时间和平均术后留置尿管时间均无明显差异(Z值分别为-1.20、-0.71、-1.40、-0.77、-0.72、-0.53,P>0.05).两组患者术中、术后并发症的发生率无明显差异(P=0.72).观察组51例患者术前接受同步放化疗,术前放化疗的总有效率为76.47%(39/51),其中CR率为23.53%(12/51),PR率为52.94%(27/51).观察组和对照组的宫颈间质浸润深度阳性率分别为29.41%和94.00%、淋巴结转移阳性率分别为9.80%和28.00%、淋巴脉管浸润阳性率分别为1.96%和14.00%,差别有统计学意义(χ2分别为44.43、5.47,均P<0.05).观察组和对照组术后接受补充放化疗的患者分别为20例和47例,差别有统计学意义(χ2=78.32,P<0.001).在随访期内,观察组有50例患者存活,对照组有47例患者存活.两组患者的3年生存率分别为98.00%和92.80%,差别无统计学意义(χ2=1.16,P=0.28).结论 机器人宫颈癌根治术用于治疗放化疗后局部晚期宫颈癌患者是安全可行的.该结论仍需大样本临床试验来证实.%Objective To explore the security and feasibility of robot-assisted radical hysterectomy (RRH) in patients with locally advanced cervical cancer (LACC) after chemoradiotherapy.Methods The clinical data of 101 LACC patients stagedⅠB2-ⅡB by International Federation of Gynecology and Obstetrics receiving RRH at Xijing Hospital of Fourth Military Medical University during March 2013 and June 2015 were selected.According to whether treated with preoperative chemoradiotherapy, they were divided into two groups.Totally 51 patients with preoperative chemoradiotherapy were divided into observation group, while 50 patients without receiving any adjuvant therapy before operation were divided into control group.RRH was performed for all patients.The operative time, intraoperative blood loss, postoperative hospital stay, intraoperative and postoperative complications, postoperative pathologic data, postoperative complementary chemoradiotherapy and recurrence survival were analyzed and compared between two groups.The clinical efficacy of preoperative chemoradiotherapy in the observation group was analyzed statistically.Results There was no significant difference in age, BMI, pelvic surgery history and pathological staging between two groups (t value was-0.48 and 0.44, χ2 value was 0.01 and 4.20, respectively, all P>0.05).The number of lymph nodes dissected during operation in the observation group was less than that in the control group, and the difference was statistically significant (Z=-4.04, P<0.001).There was no significant difference in mean operative time, mean intraoperative blood loss, mean postoperative hospital stay, mean postoperative highest temperature of patients, mean postoperative ventilation time and mean postoperative catheter indwelling time (Z value was-1.20,-0.71,-1.40,-0.77,-0.72 and-0.53, respectively, all P>0.05).There was no significant difference in incidence of intraoperative and postoperative complications between two groups (P=0.72*).The total effective rate of preoperative chemoradiotherapy was 76.47% (39/51), including 23.53% in CR rate (12/51) and 52.94% in PR rate (27/51).The positive rates of cervical interstitial infiltration in the observation group and the control group were 29.41% and 94.00%, respectively.The positive rates of lymph node metastasis were 9.80% and 28.00%, respectively.The positive rates of lymphatic vessel infiltration were 1.96% and 14.00%, respectively.The differences were statistically significant (χ2 value was 44.43 and 5.47, respectively, both P<0.05).The number of patients accepting postoperative complementary chemoradiotherapy in the observation group and the control group were 20 and 47, respectively with significant difference (χ2=78.32,P<0.001).During the follow-up period, there were 50 patients survived in the observation group, while in control group there were 47 survived patients.The three-year survival rates of two groups were 98.00% and 92.80%, respectively.The difference was not statistically significant (χ2=1.16, P=0.28).Conclusion RRH in treatment of LACC is safe and feasible.The conclusion still needs a large sample of clinical trials to confirm.
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