中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
15期
13-17
,共5页
宫颈肿瘤%肿瘤复发,局部%妇科外科手术%生育力
宮頸腫瘤%腫瘤複髮,跼部%婦科外科手術%生育力
궁경종류%종류복발,국부%부과외과수술%생육력
Uterine cervical neoplasms%Neoplasm recurrence,local%Gynecologic surgical procedures%Fertility
目的 分析年轻早期(ⅠA1～ⅠB1期)宫颈癌患者行不同入路广泛性宫颈切除术(RT)的预后情况及复发影响因素.方法 回顾性分析82例行RT年轻(＜40岁)早期宫颈癌患者的临床资料.根据不同手术入路分为两组:行腹式RT(ART)加盆腔淋巴结切除术39例(ART组),阴式RT(VRT)加腹腔镜下盆腔淋巴结切除术43例(VRT组).比较两组术中、术后和生育情况,对影响复发的临床因素采用单因素方差及多因素Cox逐步回归进行分析.结果 两组淋巴结切除数、手术时间、术后住院时间、宫颈切除长度、术后并发症发生率、术后妊娠率比较差异均无统计学意义(P＞ 0.05);VRT组术中出血量、阴道切除长度、宫旁组织切除宽度均明显小于ART组[(282.7±201.0) ml比(429.4±320.8) ml、(2.42±0.51) cm比(2.98±0.11) cm、(2.39±0.37) cm比(2.82±0.23) cm],差异有统计学意义(P＜0.05).单因素方差分析结果显示,早期宫颈癌复发与年龄、病理类型、临床分期、手术方式无关(P＞0.05),而与肿瘤直径有关(P＜0.05).多因素Cox逐步回归分析结果显示,肿瘤直径是影响到早期宫颈癌患者复发的独立危险因素(β=0.248,95％ CI0.077～0.882,P=0.032).结论 对于年轻早期宫颈癌患者实施保留生育功能的RT是可行的,VRT略优于ART,但术后妊娠结局需大样本量进一步证实,肿瘤直径是年轻早期宫颈癌患者复发重要且独立危险因素.
目的 分析年輕早期(ⅠA1～ⅠB1期)宮頸癌患者行不同入路廣汎性宮頸切除術(RT)的預後情況及複髮影響因素.方法 迴顧性分析82例行RT年輕(＜40歲)早期宮頸癌患者的臨床資料.根據不同手術入路分為兩組:行腹式RT(ART)加盆腔淋巴結切除術39例(ART組),陰式RT(VRT)加腹腔鏡下盆腔淋巴結切除術43例(VRT組).比較兩組術中、術後和生育情況,對影響複髮的臨床因素採用單因素方差及多因素Cox逐步迴歸進行分析.結果 兩組淋巴結切除數、手術時間、術後住院時間、宮頸切除長度、術後併髮癥髮生率、術後妊娠率比較差異均無統計學意義(P＞ 0.05);VRT組術中齣血量、陰道切除長度、宮徬組織切除寬度均明顯小于ART組[(282.7±201.0) ml比(429.4±320.8) ml、(2.42±0.51) cm比(2.98±0.11) cm、(2.39±0.37) cm比(2.82±0.23) cm],差異有統計學意義(P＜0.05).單因素方差分析結果顯示,早期宮頸癌複髮與年齡、病理類型、臨床分期、手術方式無關(P＞0.05),而與腫瘤直徑有關(P＜0.05).多因素Cox逐步迴歸分析結果顯示,腫瘤直徑是影響到早期宮頸癌患者複髮的獨立危險因素(β=0.248,95％ CI0.077～0.882,P=0.032).結論 對于年輕早期宮頸癌患者實施保留生育功能的RT是可行的,VRT略優于ART,但術後妊娠結跼需大樣本量進一步證實,腫瘤直徑是年輕早期宮頸癌患者複髮重要且獨立危險因素.
목적 분석년경조기(ⅠA1～ⅠB1기)궁경암환자행불동입로엄범성궁경절제술(RT)적예후정황급복발영향인소.방법 회고성분석82례행RT년경(＜40세)조기궁경암환자적림상자료.근거불동수술입로분위량조:행복식RT(ART)가분강림파결절제술39례(ART조),음식RT(VRT)가복강경하분강림파결절제술43례(VRT조).비교량조술중、술후화생육정황,대영향복발적림상인소채용단인소방차급다인소Cox축보회귀진행분석.결과 량조림파결절제수、수술시간、술후주원시간、궁경절제장도、술후병발증발생솔、술후임신솔비교차이균무통계학의의(P＞ 0.05);VRT조술중출혈량、음도절제장도、궁방조직절제관도균명현소우ART조[(282.7±201.0) ml비(429.4±320.8) ml、(2.42±0.51) cm비(2.98±0.11) cm、(2.39±0.37) cm비(2.82±0.23) cm],차이유통계학의의(P＜0.05).단인소방차분석결과현시,조기궁경암복발여년령、병리류형、림상분기、수술방식무관(P＞0.05),이여종류직경유관(P＜0.05).다인소Cox축보회귀분석결과현시,종류직경시영향도조기궁경암환자복발적독립위험인소(β=0.248,95％ CI0.077～0.882,P=0.032).결론 대우년경조기궁경암환자실시보류생육공능적RT시가행적,VRT략우우ART,단술후임신결국수대양본량진일보증실,종류직경시년경조기궁경암환자복발중요차독립위험인소.
Objective To explore the security,pregnancy outcomes,and the tumor recurrence related factors of young patients with cervical cancer treated with different radical trachelectomy (RT).Methods Eighty-two young patients (＜ 40 years) with early cervical cancer were divided into two groups based on different operation methods:vaginal radical trachelectomy (VRT) group of 43 cases and abdominal radical trachelectomy (ART) group of 39 cases.The clinical data were analyzed retrospectively,One-way Anova and Multivariate Cox Stepwise Regression analysis were used.Results The number of lymph node dissection,operation duration,postoperative hospitalization time,height of the cervical resection,incidence of postoperative complications,the postoperative pregnancy rate were no statistically significant difference between two groups(P ＞ 0.05).The blood loss,length of vaginal hysterectomy,width of parametrial resection in VRT group were significantly less than those in ART group[(282.7 ± 201.0) ml vs.(429.4 ± 320.8) ml,(2.42 ± 0.51) cm vs.(2.98 ± 0.11) cm,(2.39 ± 0.37) cm vs.(2.82 ± 0.23) cm] (P ＜ 0.05).One-way Anova analysis showed that the recurrence of early cervical cancer was related to tumor diameter size (P ＜ 0.05),while there were no correlation with age,clinical stage,histological type and surgical approach (P ＞ 0.05).Multivariate Cox Stepwise Regression analysis showed that tumor diameter size was an independent risk factor for tumor recurrence(β =0.248,95％ CI 0.077-0.882,P =0.032).Conclusions RT for young patients with early cervical cancer is feasible.Pregnancy outcomes after RT need to be studied in the future.Tumor size in diameter is the major risk factor for tumor recurrence.
