CAJ | 학술논문

目的:探讨筋膜外宫颈切除术在已完成生育但要求保留子宫的Ⅰ A1期宫颈癌患者治疗中的应用价值.方法:2005年4月至2009年7月,我们对17例已完成生育的年轻的Ⅰ A1期宫颈癌患者实施筋膜外宫颈切除术,术中切除1 cm阴道上段,子宫峡部以下的宫颈及其宫颈筋膜,并行诊断性刮宫.将切除的宫颈及官腔刮除物送快速冰冻病理切片检查,明确宫颈切缘及宫腔有无癌灶.结果:17例手术均获得成功,所有患者的宫颈切缘无肿瘤浸润,术中无膀胱及肠管损伤,平均手术时间为95分钟(80～140分钟),平均术中出血量110 ml(80～210 ml),术后平均肠功能恢复时间22小时(12～36小时),术后平均住院时间5天(4～7天),术后病率2例,宫腔粘连1例,术后病理诊断与术前诊断相符,月经正常.结论:筋膜外宫颈切除术可以在保留子宫体的情况下,将宫颈病灶切除.对于不要求保留生育功能的年轻的ⅠA1期宫颈癌患者,筋膜外宫颈切除术可能是一种能保留子宫体的安全有效的术式.
목적:탐토근막외궁경절제술재이완성생육단요구보류자궁적Ⅰ A1기궁경암환자치료중적응용개치.방법:2005년4월지2009년7월,아문대17례이완성생육적년경적Ⅰ A1기궁경암환자실시근막외궁경절제술,술중절제1 cm음도상단,자궁협부이하적궁경급기궁경근막,병행진단성괄궁.장절제적궁경급관강괄제물송쾌속빙동병리절편검사,명학궁경절연급궁강유무암조.결과:17례수술균획득성공,소유환자적궁경절연무종류침윤,술중무방광급장관손상,평균수술시간위95분종(80～140분종),평균술중출혈량110 ml(80～210 ml),술후평균장공능회복시간22소시(12～36소시),술후평균주원시간5천(4～7천),술후병솔2례,궁강점련1례,술후병리진단여술전진단상부,월경정상.결론:근막외궁경절제술가이재보류자궁체적정황하,장궁경병조절제.대우불요구보류생육공능적년경적ⅠA1기궁경암환자,근막외궁경절제술가능시일충능보류자궁체적안전유효적술식.
Objective:The clinical value of extrafascial trachelectorny was investigated in treating stage Ⅰ A1 cervical cancer to preserve fertility. Methoda:17 patients with stage Ⅰ A1 cervical carcinoma were re-cruited from April 2005 to July 2009 to have extrafascial trachelectorny. The procedure included removal of 1 cm upper portion of vagina,cervix under the isthemus,cervical fascia, and endornetrial curettage. Frozen pathology of all specimens during operation was done to rule out residual disease in uterine cavity and the cuttingrnargin of cervix. Results:All operations were finished successfully, no positive margin was found, no bladder and rectum injury. Mean operative time was 95 rain(80～140 min), mean blood loss was 110 ml(80 ～210 ml), mean recovery time of bowel function was 22 h( 12～36 h), and the mean hospitalization time was 5 d(4～7 d). There were two cases of postoperative morbidity, one case uterine cavity adhesion. All the pathology were consistant, and all patients had regular menstruation postoperatively. Concluslons:Extrafas-cial trachelectorny can removed cancer while reserving the corpus of uterus. It could be one effective proce-dure for young patients who have no desire to preserve fertility but want to keep the corpus.