Hysterectomy for obese women with endometrial cancer: Laparoscopy or laparotomy?
Hysterectomy for obese women with endometrial cancer: Laparoscopy or laparotomy?
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DOI：
10.1006/gyno.2000.5914
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发表时间：
2000-09-01
影响因子：
4.7
通讯作者：
Garafano, LL
中科院分区：
文献类型：
--
作者：
Eltabbakh, GH;Shamonki, MI;Garafano, LL
Objective.本研究的目的是探讨腹腔镜治疗肥胖妇女早期子宫内膜癌的可行性和安全性，并比较这些妇女和剖腹手术治疗的手术结果、费用、住院时间、术后疼痛控制的回忆、恢复完全活动和工作的时间以及总体满意度。我们进行了一项为期2年的前瞻性研究，将腹腔镜手术应用于所有临床I期子宫内膜癌且体重指数（BMI）在28.0至60.0之间且能够耐受此类手术的女性。作为对照，我们使用了在过去2年中接受剖腹手术的临床I期子宫内膜癌和相似BMI的女性。比较两组患者的特征、手术结果、费用和住院时间，并就恢复时间、术后疼痛控制的回忆和对治疗的总体满意度进行访谈。在研究期间，42名患有临床I期子宫内膜癌的肥胖妇女中有40名接受了腹腔镜手术。3例（7.5%）患者转为剖腹手术。因此，腹腔镜手术在88.1%的肥胖女性中获得成功。接受腹腔镜手术的妇女和接受开腹手术的妇女在患者特征、接受淋巴结切除术的妇女比例、并发症、总费用、患者对术后疼痛的回忆以及患者对管理的满意度方面没有显著差异。接受腹腔镜手术的女性手术时间明显延长，切除的盆腔淋巴结更多，术后红细胞压积下降较小，止痛药较少，住院时间较短（194.8 vs 137.7 min，P
Objective. The aim of this study was to investigate the feasibility and safety of laparoscopic management of obese women with early stage endometrial cancer and to compare the surgical outcome, cost, hospital stay, recall of postoperative pain control, time to return to full activity and to work, and overall satisfaction among these women and those managed by laparotomy.Methods. We conducted a prospective study over 2 years applying laparoscopic surgery to all women with clinical stage I endometrial cancer and body mass indices (BMIs) between 28.0 and 60.0 who can tolerate such surgery. As a control, we used women with clinical stage I endometrial cancer and similar BMIs who underwent laparotomy in the previous 2 years. Both groups were compared in their characteristics, surgical outcome, cost, and hospital stay, and interviewed regarding time to recovery, recall of postoperative pain control, and overall satisfaction with their management.Results. Forty of 42 obese women who presented with clinical stage I endometrial cancer during the study period were offered laparoscopic surgery. The procedure was converted to laparotomy in 3 (7.5%) patients. Laparoscopic surgery was thus successful in 88.1% of all obese women. There was no significant difference between women who underwent laparoscopy and those who underwent laparotomy in patient characteristics, proportion of women who underwent lymphadenectomy, complications, total cost, patients' recall of postoperative pain, and patients' satisfaction with management. Women who underwent laparoscopy had a significantly longer operative time, more pelvic lymph nodes removed, a smaller drop in postoperative hematocrit, less pain medication, and a shorter hospital stay (194.8 versus 137.7 min, P