保留子宫切除术对年轻早期宫颈癌患者预后的影响
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摘要
目的探讨保留子宫切除术对年轻早期宫颈癌患者生育功能及预后的影响。方法选择28例行全腹腔镜广泛宫颈切除术(radical trachelectomy,RT)的早期宫颈癌患者作为观察组;选择同期31例行腹腔镜下子宫广泛性切除术(radical hysterectomy,RH)的早期宫颈癌患者作为对照组。比较2组患者术后标本检查的相关指标、术后生育情况以及术后随访情况。结果①观察组28例患者中,顺利完成保留生育功能手术的有27例,因术中快速冰冻,病理检查阳性,1例改行腹腔镜下RH。②2组切除的宫骶韧带长度、主韧带长度、阴道长度,切除的盆腔淋巴结数相比,差异均无统计学意义(P> 0. 05)。③术后的生育情况:观察组成功保留生育功能的27例患者中,有妊娠愿望的患者仅15例,其中妊娠6例,包括早产2例、自然流产1例、足月分娩3例。④术后的随访情况:对照组术后平均随访时间为30. 1个月,复发率3. 22%;观察组术后平均随访时间为29. 3个月,复发率3. 85%。2组患者复发率进行比较,差异无统计学意义(P>0. 05)。结论年轻早期宫颈癌患者行腹腔镜下RT手术,安全有效,且复发率较低,但其妊娠结局有待进一步的改善。
Objective To explore the outcomes of the oncology,the fertility and prognosis on young patients with earlystage cervical cancer after undergoing fertility-sparing treatments. Methods A total of 28 patients with cervical cancer( stageⅠa2 ~ Ⅰb1) who had undergone total laparoscopic RT in our hospital were chosen as the observation group. A total of 31 patients with cervical cancer( stage Ⅰa2 ~ Ⅰb1) who had undergone total laparoscopic RH in our hospital from August 2011 to September 2015 were chosen as the control group. The postoperative specimen examination,fertility after surgery and follow-up results were compared between the two groups. Results ① Among these 28 patients in the observation group,quick frozen pathological examinations were positive in 1 cases,which underwent total laparoscopic RH eventually. ② compared with the observation group and the control group,P > 0. 05,there were no significant difference in number of length of removed uterosacral ligament,length of removed cardinal ligament,length of removed vaginal,removed lymphatic nodes,( P > 0. 05). ③ Fertility after surgery results: in the observation group,only 15 patients had fertility requirement after treatments. Pregnancies occurred in 6 women,which included,2 case of preterm labor,1 cases of spontaneous abortion and 3 case of full-term labor. ④ Postoperative tumor follow-up results: The average follow-up time in postoperative patients of the control group was 30. 1,and 29. 3 months in the observation group. In follow-up period,compare with the control group and the observation group,P > 0. 05,there was no significant difference in the recurrence rate( 3. 22%,3. 85%)( P > 0. 05). Conclusion total laparoscopic RT on young patients with earlystage cervical cancer was safe,the recurrence rate is low,but the outcome of the pregnancy is still need to improve.
Objective To explore the outcomes of the oncology,the fertility and prognosis on young patients with earlystage cervical cancer after undergoing fertility-sparing treatments. Methods A total of 28 patients with cervical cancer( stageⅠa2 ~ Ⅰb1) who had undergone total laparoscopic RT in our hospital were chosen as the observation group. A total of 31 patients with cervical cancer( stage Ⅰa2 ~ Ⅰb1) who had undergone total laparoscopic RH in our hospital from August 2011 to September 2015 were chosen as the control group. The postoperative specimen examination,fertility after surgery and follow-up results were compared between the two groups. Results ① Among these 28 patients in the observation group,quick frozen pathological examinations were positive in 1 cases,which underwent total laparoscopic RH eventually. ② compared with the observation group and the control group,P > 0. 05,there were no significant difference in number of length of removed uterosacral ligament,length of removed cardinal ligament,length of removed vaginal,removed lymphatic nodes,( P > 0. 05). ③ Fertility after surgery results: in the observation group,only 15 patients had fertility requirement after treatments. Pregnancies occurred in 6 women,which included,2 case of preterm labor,1 cases of spontaneous abortion and 3 case of full-term labor. ④ Postoperative tumor follow-up results: The average follow-up time in postoperative patients of the control group was 30. 1,and 29. 3 months in the observation group. In follow-up period,compare with the control group and the observation group,P > 0. 05,there was no significant difference in the recurrence rate( 3. 22%,3. 85%)( P > 0. 05). Conclusion total laparoscopic RT on young patients with earlystage cervical cancer was safe,the recurrence rate is low,but the outcome of the pregnancy is still need to improve.
引文
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[8]熊菊香,王沂峰,陈高文,等.改良腹式与全腹腔镜广泛宫颈切除术治疗早期宫颈癌的比较[J].实用妇产科杂志,2015,31(4):310-314.
[9]刘开江,刘青,韩娜娜,等.腹腔镜下保留生育功能宫颈癌根治术治疗早期子宫颈癌的近期临床疗效[J].中国医学科学院学报,2011,33(4):436-439.
[10]刘建和,张劲松,方克伟,等.改良腹腔镜下网片宫颈-骶前韧带固定术治疗子宫颈延长伴子宫脱垂的疗效及安全性[J].中华泌尿外科杂志,2016,37(11):846-850.
[11]Plante M.Vaginal radical trachelectomy:an update[J].Gynecol Oncol,2008,111(Suppl 2):S105-S110.
[12]Lu Q,Liu C,Zhang Z.Total laparoscopic radical trachelectomy in the treatment of early-stage cervical cancer:review of technique and outcomes[J].Curr Opin Obstet Gynecol,2014,26(4):302-307.
[2]叶倩,饶金,郜红艺,等.754例宫颈癌流行病学分析[J].中国妇幼保健,2013,28(19):3068-3070.
[3]陈晓梅,卢昆林.腹腔镜辅助下阴式广泛全子宫切除加盆腔淋巴结清扫术治疗宫颈癌的临床分析[J].临床军医杂志,2015,43(1):53-54.
[4]付鑫,陈珊珊.广泛全子宫切除术联合盆腔淋巴结清扫术治疗早期宫颈癌的护理观察[J].检验医学与临床,2015,12(3):409-411.
[5]阳志军,韦任姬,李力.卵巢恶性生殖细胞肿瘤保留生育功能手术患者预后及生育能力的影响因素分析[J].中华妇产科杂志,2012,47(12):898-904.
[6]Suprasert P,Srisomboon JK,Siriaungul S,et al.Outcomes of abandoned radical hysterectomy in patients with stagesⅠB-ⅡA cervical cancer found to have positive nodes during the operation[J].Int J Gynecol Cancer,2005,15(3):498-502.
[7]孙秀利,任倍莹.腹腔镜手术治疗Ⅰa2~Ⅱb期宫颈癌的临床疗效观察[J].实用癌症杂志,2016,31(7):1156-1158.
[8]熊菊香,王沂峰,陈高文,等.改良腹式与全腹腔镜广泛宫颈切除术治疗早期宫颈癌的比较[J].实用妇产科杂志,2015,31(4):310-314.
[9]刘开江,刘青,韩娜娜,等.腹腔镜下保留生育功能宫颈癌根治术治疗早期子宫颈癌的近期临床疗效[J].中国医学科学院学报,2011,33(4):436-439.
[10]刘建和,张劲松,方克伟,等.改良腹腔镜下网片宫颈-骶前韧带固定术治疗子宫颈延长伴子宫脱垂的疗效及安全性[J].中华泌尿外科杂志,2016,37(11):846-850.
[11]Plante M.Vaginal radical trachelectomy:an update[J].Gynecol Oncol,2008,111(Suppl 2):S105-S110.
[12]Lu Q,Liu C,Zhang Z.Total laparoscopic radical trachelectomy in the treatment of early-stage cervical cancer:review of technique and outcomes[J].Curr Opin Obstet Gynecol,2014,26(4):302-307.