| Objective:To investigate the effect of laparoscopic and open radical hysterectomy on pathological results of cervical cancer.Methods:A retrospective analysis was made on 193 patients with cervical squamous cell carcinoma diagnosed as cervical squamous cell carcinoma in the Department of Gynecology,Guizhou Cancer Hospital and affiliated Hospital of Guizhou Medical University from April 2018 to January 2020.Radical hysterectomy was performed in stage IB1-IIA2 of cervical squamous cell carcinoma.There were 87 cases of open radical resection of cervical cancer and 106 cases of laparoscopic radical resection of cervical cancer.according to the mode of operation and postoperative routine pathological results,the difference of pathological results between laparoscopic and open radical resection of cervical cancer was statistically analyzed.To observe and record the similarities and differences between laparoscopic and open radical resection of cervical cancer,the flow chart of pathological diagnosis of cervical cancer in pathology department,and observe the histomorphology of HE staining margin of pathological tissue under microscope.Results:1.Comparison between laparoscopy and laparotomy: a.The average age of the patients in the laparoscopy group was lower than that in the laparotomy group(47.08±8.99 y VS 50.38 ±10.65 y,p=0.021).The average hospital stay in the laparoscopy group was less than that in the laparotomy group(17.56 ± 6.28 days VS 19.58 ±4.72 days,p=0.014).b.The number of lymph nodes removed during operation in the laparoscopic group was 23.37 ±7.04,which was less than that in the open group(26.78 ±10.77).c.Postoperative supplementary radiotherapy and chemotherapy: 34 cases in the laparotomy group(34/87,39.1%),which was higher than 23 cases in the laparoscopy group(23/87,21.7%)(p=0.008).Among them,the pathological results showed that there were 24 cases of high risk factors in the laparotomy group(24/87,27.6%)and 25 cases in the laparoscopy group(25/106,23.6%).There were 47 cases in the laparotomy group(47/87,54.0%)and 49 cases in the laparoscopy group(49/106,46.2%).There was no significant difference between the two groups(p>0.05).However,it can be seen that the proportion of risk factors in the laparotomy group was higher than that in the laparoscopy group.2.Subgroup analysis: A.stage IB1: the average hospital stay was 16.42 ±4.65 days in the laparoscopy group and 19.59 ±4.87 days in the laparotomy group.The average maximum diameter of the tumor in the laparoscopy group was larger than that in the laparotomy group(2.07 ±1.74 cm VS1.10 ± 1.23cm).However,there was no significant difference in operation time,intraoperative vaginal resection length,number of lymph nodes,risk factors and postoperative radiotherapy and chemotherapy rate(p > 0.05).b.In stage IIA1,the number of lymph nodes removed during operation in the laparoscopy group was less than that in the laparotomy group(21.70 ± 6.29 VS 26.67 ± 10.96,p=0.02),but there was no significant difference in the average hospital stay,operation time,maximum diameter of the tumor,intraoperative vaginal resection length,risk factors and postoperative radiotherapy and chemotherapy rate in the laparoscopy group(p >0.05),but there was no significant difference in the average hospital stay,operation time,maximum diameter of the tumor,intraoperative vaginal resection length,risk factors and postoperative radiotherapy rate in the laparoscopy group.3.a.To observe the surgical process of the two surgical methods,laparotomy and laparoscopy for radical resection of cervical cancer in the surgical steps,the scope of surgical resection is the same,the difference is the use of electrosurgical instruments.b.In the pathological section,the pathologist did not judge the cutting edge of the injury,but only judged whether there was tumor cell infiltration from the part that could distinguish the shape of the cell as the cutting edge.In this study,we focused on observing the cutting edge of the tissue that could not be identified by the injury ignored by pathologists,and observing the morphological changes of stained cells in HE sections to judge the degree of injury.c.10 cases of main ligament or round ligament incisal margin resected by operation in two groups were collected,microscopic observation: laparoscopic resection of tissue margin with electrosurgical instruments showed pathological changes of thermal injury tissue,the depth range was about 3.5mm-7.2mm,the average value was 5.46 mm.Although there was no tissue thermal injury in the incision margin of laparotomy with cold knife under tissue microscope,the cell injury could be seen in the part of vascular clamp.The depth of injury ranged from 2.0mm-4.6mm,with an average of 3.7mm.In the laparotomy group,the maximum depth of thermal injury of the incisal margin was2.6mm-5.2mm,with an average of 3.88 mm.In the patients undergoing radical hysterectomy with two surgical methods,the postoperative radiotherapy and chemotherapy rate in the laparotomy group was higher than that in the laparoscopy group.In the subgroup analysis,the tumor diameter in the IB1 laparoscopy group was larger than that in the laparotomy group.The tumor diameter in the laparoscopy group was larger than that in the laparotomy group,which led to an increase in the proportion of postoperative radiotherapy and chemotherapy,but the postoperative radiotherapy and chemotherapy rate in the laparotomy group was higher than that in the laparoscopy group.There may be a factor that too much coagulated tissue in the laparoscopic group affects the actual interpretation results of the incisal margin tissue in the process of using electrosurgical instruments,resulting in false negative pathological results.Conclusions:1.According to the observation of the data in this group,the postoperative radiotherapy and chemotherapy in the laparotomy group was higher than that in the laparoscopy group.Laparoscopy and laparotomy were considered because different surgical instruments had an impact on the tissue cutting edge,which affected the judgment of pathological results.2.The survival rate of laparoscopic radical resection of cervical cancer is lower than that of laparotomy group.Whether different surgical instruments affect the judgment of pathological results leading to postoperative supplementary treatment,we need to collect more data to confirm. |
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