标题：腹腔镜下广泛子宫切除术治疗宫颈癌的疗效及其对患者血清肿瘤标记物水平的影响

      作者：秦璐，庞小玲，秦继胜，韦笑    (桂林市中西医结合医院妇产科，广西 桂林 541004)

      卷次： 2018年29卷20期

      【摘要】 目的 探讨腹腔镜下广泛子宫切除术治疗宫颈癌的疗效及其对患者血清肿瘤标记物水平的影响。方法 选择2015年1月至2017年6月期间桂林市中西医结合医院妇产科收治的62例宫颈癌患者为研究对象，根据随机数表法分为观察组和对照组，每组31例，对照组患者采用开腹广泛子宫切除术治疗，观察组患者则应用腹腔镜下广泛子宫切除术，比较两组患者的围手术期临床指标，术前及术后7 d血清糖类抗原(CA125)、癌胚抗原(CEA)；术后1年采用生活质量调查表(QOL-UCC)评价生存质量；随访术后复发率及死亡率。结果 观察组和对照组患者的手术时间[(150.5±35.6) min vs (202.4±50.8) min]、术中出血量[(219.6±74.5) mL vs (380.6±110.7) mL]、肛门排气时间[(1.5±0.6) d vs (2.6±0.8) d]、术后住院天数[(16.6±3.2) d vs (22.8±4.3) d]、并发症发生率(29.03% vs 54.84%)比较，观察组均明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者术后血清CA125、CEA分别为(34.2±11.5) ng/mL和(22.6±8.2) ng/mL、对照组分别为(32.7±15.8) ng/mL和(21.8±7.6) ng/mL，两组患者的上述指标均较术前明显降低，差异有统计学意义(P<0.05)，但是术后两组患者间比较差异均无统计学意义(P>0.05)；术后 1年，观察组患者的QOL-UCC评分中身体状况和心理状况评分分别为(4.42±0.28)分、(4.13±0.19)分，明显高于对照组的(4.14±0.15)分、(3.87±0.14)分，差异均有统计学意义(P<0.05)；观察组随访期间复发率为 16.13%，死亡率为 6.45%，与对照组的12.90%、3.23%比较，差异均无统计学意义(P>0.05)。结论 腹腔镜下广泛子宫切除术和开腹手术治疗宫颈癌均可显著降低血清肿瘤标志物水平，二者疗效相当，但是腹腔镜下手术具有创伤小、并发症发生率低及术后恢复快的优点，患者术后生存质量更佳。
      【关键词】 腹腔镜；子宫切除术；宫颈癌；肿瘤标记物；生存质量
      【中图分类号】 R737.33 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2866—03

Efficacy of laparoscopic radical hysterectomy for cervical cancer and its effect on serum tumor markers.
QIN Lu,PANG Xiao-ling, QIN Ji-sheng, WEI Xiao. Department of Obstetrics and Gynecology, Guilin Integrated Traditional Chineseand Western Medicine Hospital, Guilin 541004, Guangxi, CHINA
【Abstract】 Objective To investigate the efficacy of laparoscopic radical hysterectomy for cervical cancer andits effect on serum tumor markers. Methods A total of 62 cases of cervical cancer, treated in Department of Obstetricsand Gynecology of Guilin Integrated Traditional Chinese and Western Medicine Hospital from January 2015 to June2017, were selected and divided into the observation group and the control group according to the random number tablemethod, with 31 cases in each group. The control group was treated with open abdominal hysterectomy, and the observa-tion group applied laparoscopic extensive hysterectomy. The clinical indexes of the two groups were observed in the peri-operative period. The changes of serum CA125 and CEA before and after the operation (7 days) were observed, and qual-ity of life was evaluated by quality of life questionnaire (QOL-UCC) at 1 year after the operation. The recurrence rateand mortality at follow-up were recorded. Results The operation time, amount of bleeding, time of anus exhaust, hospi-talization time and complications rate in the observation group were (150.5±35.6) min, (219.6±74.5) mL, (1.5±0.6) d,(16.6±3.2) d, 29.03%, respectively, which were significantly lower than corresponding (202.4±50.8) min, (380.6±110.7) mL,(2.6±0.8) d, (22.8±4.3) d, 54.84% in the control group (P<0.05). The serum CA125 and CEA were (34.2±11.5) ng/mL and(22.6±8.2) ng/mL in the observation group, (32.7±15.8) ng/mL and (21.8±7.6) ng/mL in the control group, which were sig-nificantly lower than those before the operation (P<0.05), but there was no significant difference between the two groups(P<0.05). At the 1 year after the operation, the physical condition and mental state of the QOL-UCC score in the observa-tion group were respectively (4.42±0.28) and (4.13±0.19), which were significantly higher than corresponding (4.14±0.15)and (3.87±0.14) in the control group (P<0.05). The recurrence rate and mortality of the observation group were 16.13%and 6.45% versus 12.90% and 3.23% of the control group (P>0.05). Conclusion Laparoscopic extensive hysterectomyand open abdominal hysterectomy for cervical cancer can significantly reduce the serum tumor markers. The two meth-ods are effective, but the laparoscopic operation has the advantages of small trauma, low complication rate and quick re-covery after operation, and the patient's quality of survival is better.
      【Key words】 Laparoscopy; Hysterectomy; Cervical cancer; Tumor marker; Quality of life (QOL)·论 著·doi:10.3969/j.issn.1003-6350.2018.20.017