Clinical Comparative Study Of Hand-assisted Laparoscopic And Laparotomic Cytoreductive Surgery Of Ovarian Malignant Tumor

Objective: With the rapid develop of medical technology,the treatment of gynecological malignant tumor is from the traditional laparotomy gradually to the minimally invasive surgery,however,the specific surgical method of ovarian cancer is the discussion focus during the gynecologic clinical doctors all the time,especially for multiple organ metastasis and dense basin celiac adhesion in patients with advanced ovarian cancer.This study is to discuss a surgery that combined the feedback of tactile sensation and the idea of minimally invasive surgery,and to explain the short-term clinical effects of the hand-assisted laparoscopic and laparotomic cytoreductive surgery of ovarian malignant tumor,and to offer a new idea to the clinic treatment of ovarian cancer.Methods:1 Cases collected: Patients with ovarian malignant tumor from November2014 to November 2016 were randomly divided into HALS group(n=18)and open group(n=40).All the patients had not received chemotherapy preoperation,and the pathological stage of all the patients belong to ovarian epithelingenic malignant tumor.All the cases are staged according to FIGO,and received standard TP chemotherapy.2 Compare the general information: The age of HALS and OS is[(58.33±8.19)year VS(55.95±7.29)year,P>0.05],the complications of patients are hypertension,diabetes,obesity,hypoproteinemia,operation history of abdominopelvic cavity and so on.The general informations of two groups were not statistically significant.3 Preoperative preparation,anesthesia ways,position and operation.4 Observation index: length of operational cut,time of operation,blood loss of operation,the size of residual tumor postoperation,gastrointestinalrecovery time postoperation,the hospitalization time postoperation,the first chemotherapy time,the pathological stage postoperation,and the survival situation of all patients.5 Statistical treatment: We analyze the datas with SPSS 21.0,and analyze measurement datas and enumeration datas with t-test and ?2-test respectively.We describe survival curve with Kaplan-Meier.The inspection standard is?=0.05,and P<0.05 is statistically significant.Results:1 As compared to the open surgery group,the HALS group had significantly shorter operational cut [(7.22±0.42)cm vs(22.73±1.54)cm,p<0.05],less blood loss [(569.44±249.79)mL vs(881.50±539.73)mL,P<0.05],shorter gastrointestinal recovery time [(2.89±0.90)d vs(3.95±0.88)d,P<0.05],shorter first chemotherapy time of postoperation [(11.07±3.26)d vs(13.54±3.06)d,P<0.05];But the hospitalization time [(18.17±5.35)d vs(18.20±3.93)d,P>0.05] and the operative time [(263.61±70.86)min vs(275.00±29.96)min,P>0.05] were not statistically significant between HALS group and OS group.The degree of satisfaction of HALS group was higher than open surgery group(P< 0.05).2 The serous tumors?the mucinous tumors?the endometrial tumors?the clear cell tumors and the other tumors of HALS group respectively were 66.66percent?11.11 percent?5.56 percent?0 percent?16.67 percent;and similarly the serous tumors?the mucinous tumors?the endometrial tumors?the clear cell tumors and the other tumors of OS group respectively were 60 percent,17.5percent,7.5 percent,10 percent,5 percent.The tumor stage of HALS group and OS group from I,II,III to IV respectively were 0 percent,0 percent,77.78 percent,22.22 percent,15 percent,5 percent,62.5percent,17.5percent.3 From November 2014 to November 2016,there were not statistically significance between HALS group and OS group in the survival rate of patients.Conclusion:1 As compared to the open surgery group,HALS can not reduce theeffectiveness of treatment,and HALS has the following advantages,such as safety,feasibility,mini-invasion,rapid recovery,optimal cytoreductive surgery and so on.2 We can operate laparoscopic cytoreductive surgery in early ovarian cancer,however,we can complete the satisfy cytoreductive surgery with HALS in most advanced ovarian cancer.In other advanced ovarian cancer,we can apply neoadjuvant chemotherapy first and then carry out the cytoreductive surgery.We can improve the prognosis with sensitive chemotherapy drugs.