机器人手术与传统开腹术治疗早期宫颈癌的效果分析

doi:10.3877/cma.j.issn.1674-6899.2023.05.008

目的

比较机器人手术和开腹手术治疗ⅠA1-ⅡA2期宫颈癌患者的手术效果和肿瘤学结局。

方法

回顾性分析2016年至2018年南昌大学第一附属医院妇产科收治的164例ⅠA1-ⅡA2期宫颈癌患者的临床资料，所有患者术前均未接受放疗或化疗；其中116例接受机器人手术(机器人组)根治性子宫切除术及盆腔淋巴结清扫，48例接受开腹手术(开腹手术组)。比较两手术组的手术效果和肿瘤学结局。

结果

两组患者在手术时间、手术并发症、盆腔淋巴结切除数、手术切缘阳性、宫旁受累和淋巴结转移方面差异均无统计学意义(P>0.05)。在手术失血量、术后住院时间和肠功能恢复方面，机器人组的结果分别优于开腹手术组(P<0.05)。机器人组68例患者术后接受辅助治疗，开腹手术组19例患者接受辅助治疗(P<0.05)。机器人组的随访时间与开腹手术组无明显差异(52.32±11.18 vs. 56.17±15.05月，P>0.05)。两组复发率和死亡率差异均无统计学意义(P＝0.95，P＝0.68)。

结论

与开腹手术相比，机器人手术结合术后辅助治疗对早期宫颈癌是可行和安全的，具有良好的手术效果和同等的肿瘤学结局。

关键词: 宫颈癌, 根治性子宫切除术, 机器人手术, 开腹手术

Objective

To compare surgical and oncological outcome of robotic surgery and laparotomy for the treatment of stage IA1 to IIA2 cervical cancer.

Methods

A retrospective study were performed in a university-affiliated tertiary hospital between 2016 and 2018. One hundred and sixty-four patients with stage IA1-IIA2 cervical carcinoma without preoperative brachytherapy or chemotherapy were included, of whom 116 underwent robotic and 48 underwent laparotomic radical hysterectomy with pelvic lymph node dissection performed. The surgical and oncological parameters of two surgical groups were compared.

Results

There were no significant differences between the two groups in operative time, intraoperative and postoperative complications, pelvic lymph node, positive surgical margins, parametrial involvement and lymph node metastasis respectively (P>0.05). In terms of blood loss, postoperative hospital stay and bowel function recovery, the outcomes of robotic group were more favorable than those of laparotomy group respectively (P< 0.05). Sixty-eight patients in robotic group accepted adjuvant therapy postoperation while 19 patients in laparotomy group accepted therapy (P< 0.05). No significant difference was found in follow-up time between the two groups (52.32 ± 11.18 vs. 56.17 ± 15.05 months, P>0.05). There were no significant differences between the two groups in recurrence and death rate (P> 0.05).

Conclusion

With adjuvant therapy postoperation, robotic surgery for early cervical cancer seems to be feasible and safe with favorable short-term surgical and equivalent oncological outcomes.

Key words: Cervical cancer, Radical hysterectomy, Robotic surgery, Laparotomy

图1 机器人手术的穿刺孔位置注：通过12 mm trocar在距脐左侧2 cm的位置引入30度机器人腹腔镜头。两个机器人trocar(8 mm)位于腹腔镜端口两侧8 cm处，第四个位于右侧髂嵴的上方。

图2 机器人根治性子宫切除术步骤注：A.子宫圆韧带切除术(左)；B.子宫圆韧带切除术(右)；C.盆腔淋巴结清扫术(左)；D.盆腔淋巴结清扫术(右)；E.子宫动脉游离和离断(左)；F.子宫动脉游离和离断(右)；G.输尿管隧道游离(左)；H.输尿管隧道游离(右)；I.子宫主韧带和子宫骶韧带切除术(左)；J.子宫主韧带和子宫骶韧带切除术(右)；K.部分阴道切除术；L.阴道缝合。

表1 机器人手术和开腹手术组患者的肿瘤特征[n(%)]

	机器人组(n＝116)	开腹组(n＝48)	P值
年龄(岁)	49.20 ± 8.48	50.60 ± 9.20	0.37
FIGO分期			<0.001
ⅠA1	16 (13.80)	1 (2.10)
ⅠA2	6 (5.20)	2 (4.20)
ⅠB1	49 (42.20)	39 (81.30)
ⅠB2	10 (8.60)	5 (10.40)
ⅡA1	32 (27.60)	1 (2.10)
ⅡA2	3 (2.60)	0 (0.00)
组织学			0.88
鳞状细胞癌	106 (91.40)	45 (93.80)
腺癌	8 (6.90)	2 (4.20)
其他	2 (1.70)	1 (2.10)
肿瘤分化程度			0.89
Ⅰ	32 (27.60)	15 (31.30)
Ⅱ-Ⅲ	77 (66.40)	30 (62.50)
未定义	7 (6.00)	3 (6.30)
肿瘤大小			0.88
≤4 cm	103 (88.80)	43 (89.60)
>4 cm	13 (11.20)	5 (10.40)

表1 机器人手术和开腹手术组患者的肿瘤特征[n(%)]

	机器人组(n＝116)	开腹组(n＝48)	P值
年龄(岁)	49.20 ± 8.48	50.60 ± 9.20	0.37
FIGO分期			<0.001
ⅠA1	16 (13.80)	1 (2.10)
ⅠA2	6 (5.20)	2 (4.20)
ⅠB1	49 (42.20)	39 (81.30)
ⅠB2	10 (8.60)	5 (10.40)
ⅡA1	32 (27.60)	1 (2.10)
ⅡA2	3 (2.60)	0 (0.00)
组织学			0.88
鳞状细胞癌	106 (91.40)	45 (93.80)
腺癌	8 (6.90)	2 (4.20)
其他	2 (1.70)	1 (2.10)
肿瘤分化程度			0.89
Ⅰ	32 (27.60)	15 (31.30)
Ⅱ-Ⅲ	77 (66.40)	30 (62.50)
未定义	7 (6.00)	3 (6.30)
肿瘤大小			0.88
≤4 cm	103 (88.80)	43 (89.60)
>4 cm	13 (11.20)	5 (10.40)

表2 两组患者的手术结果[n(%)]

	机器人组(n＝116)	开腹组(n＝48)	P值
手术时间(min)	193.20±31.59	194.60±33.72	0.80
双侧输卵管卵巢切除术	68(58.60)	30(62.50)	0.64
手术失血量(ml)	142.20±80.23	356.30±266.50	<0.001
术后住院天数(d)	7.50±1.49	8.60±3.71	0.04
肠功能恢复(d)	2.10±0.40	3.00±0.44	<0.001
盆腔淋巴结(个)	21.20±9.94	22.50±8.87	0.43
手术切缘阳性	3(2.60)	2(4.20)	0.97
LVSI阳性	26(22.40)	1(2.10)	0.001
宫旁组织受累	2(1.70)	1(2.10)	>0.99
淋巴结转移	16(13.80)	9(18.80)	0.42
中转开腹手术	0(0.00)	－	－

表2 两组患者的手术结果[n(%)]

	机器人组(n＝116)	开腹组(n＝48)	P值
手术时间(min)	193.20±31.59	194.60±33.72	0.80
双侧输卵管卵巢切除术	68(58.60)	30(62.50)	0.64
手术失血量(ml)	142.20±80.23	356.30±266.50	<0.001
术后住院天数(d)	7.50±1.49	8.60±3.71	0.04
肠功能恢复(d)	2.10±0.40	3.00±0.44	<0.001
盆腔淋巴结(个)	21.20±9.94	22.50±8.87	0.43
手术切缘阳性	3(2.60)	2(4.20)	0.97
LVSI阳性	26(22.40)	1(2.10)	0.001
宫旁组织受累	2(1.70)	1(2.10)	>0.99
淋巴结转移	16(13.80)	9(18.80)	0.42
中转开腹手术	0(0.00)	－	－

表3 两组患者的肿瘤学结果[n(%)]

	机器人组(n＝116)	开腹组(n＝48)	P值
术后辅助治疗	68(58.60)	19(39.60)	0.03
随访时间(月)	52.32±11.18	56.17±15.05	0.07
复发	10(8.60)	5(10.40)	0.95
死亡	6(5.20)	4(8.30)	0.68

表3 两组患者的肿瘤学结果[n(%)]

	机器人组(n＝116)	开腹组(n＝48)	P值
术后辅助治疗	68(58.60)	19(39.60)	0.03
随访时间(月)	52.32±11.18	56.17±15.05	0.07
复发	10(8.60)	5(10.40)	0.95
死亡	6(5.20)	4(8.30)	0.68

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Surgical and oncological outcome of robotic surgery compared with conventional laparotomy in the management of early cervical cancer

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Surgical and oncological outcome of robotic surgery compared with conventional laparotomy in the management of early cervical cancer