摘要：
目的 探讨无气腹腹腔镜治疗中老年宫颈癌患者的安全性及临床应用价值. 方法 回顾性分析2014年6月~2015年10月年龄>50岁的腹腔镜宫颈癌根治术50例临床资料,其中无气腹手术24例,气腹手术26例,比较2组气腹前、术中60 min时平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、吸气峰压(peak inspiratory pressure,PIP)、呼气末CO2分压(PETCO2),以及手术时间、术中出血量、清扫淋巴结数目、切除阴道壁长度、住院费用、肛门排气时间、术后住院时间、并发症等指标. 结果 无气腹组术中MAP、PIP、PETCO2、HR与术前无统计学差异(P>0.05);气腹组术中MAP、PIP、PETCO2较术前明显升高(t=-6.669、-7.636、-4.387,P均=0.000),HR无统计学差异(t=-1.443,P=0.161).2组手术时间、术中出血量、清扫淋巴结数、切除阴道壁长度无统计学差异(P>0.05).无气腹组肛门排气时间、术后住院时间、住院费用均明显少于气腹组[(2.0±0.6)d vs.(2.5±0.5)d,t=-2.886,P=0.006;(7.4±1.3)d vs.(8.2±1.4)d,t=-2.072,P=0.044;(2.0±0.6)万元 vs.(2.5±0.5)万元,t=-3.853,P=0.000].2组均无术中并发症发生,术后淋巴潴留囊肿分别为17%(4/24)、19%(5/26),无统计学差异(X2=0.000,P=1.000). 结论 无气腹腹腔镜宫颈癌根治术避免气腹对人体血流动力学的影响,术中呼吸循环系统稳定,术后肠道功能恢复快,住院时间短,可达到腹腔镜宫颈癌手术同样的根治效果,中老年患者接受无气腹腹腔镜宫颈癌根治术是安全可行的.%Objective To evaluate the safety and clinical value of gasless laparoscopic radical hysterectomy in patients older than 50 years old.Methods In this retrospective study, data were analyzed on 50 patients (older than 50 years old) with cervical cancer in our hospital from June 2014 to October 2015, treated either by gasless laparoscopic (n=24) or laparoscopic hysterectomy (n=26).The mean arterial pressure (MAP), heart rate (HR), peak inspiratory pressure (PIP) and PETCO2 were measured at before surgery (T0) and 60 minutes after pneumoperitoneum (T1).The operation time, intraoperative blood loss, number of lymph nodes resection, length of vaginal wall removed, costs, time to flatus, postoperative hospital stay and complications were compared between the two groups.Results There were no significant differences in MAP, PIP, PETCO2, HR at T0 and T1 timepoints in the gasless group.In the laparoscopic group, the MAP, PIP, and PETCO2 were significantly higher at T1 than T0 timepoint (t=-6.669,-7.636, and-4.387, P=0.000).There was no significant difference in HR between T0 and T1 in the laparoscopic group(t=-1.443,P=0.161).There were no significant differences in operation time, blood loss, lymph nodes and length of vaginal wall removed between the gasless group and the laparoscopic group (P>0.05).The time to flatus, postoperative hospital stay, and costs were significantly less in the gasless group than those in the laparoscopic group [(2.0±0.6) d vs.(2.5±0.5) d, t=-2.886, P=0.006;(7.4±1.3) d vs.(8.2±1.4) d, t=-2.072, P=0.044;(2.0±0.6) ×104 yuan vs.(2.5±0.5) ×104 yuan, t=-3.853, P=0.000].There was no significant difference in the incidence of lymphocyst between the two groups [17% (4/24) vs.19% (5/26), X2=0.000, P=1.000].Conclusions The gasless laparoscopic surgery can inhibit the stress reaction of CO2 pneumoperitoneum, and thus stabilize hemodynamics, with fast postoperative bowel recovery and short hospitalization.The procedure is comparable of laparoscopic surgery in clinical effects, being a safe and feasible option for elderly patients.
