CAJ | 학술논문

目的探讨年轻的早期(Ⅰa1～ Ⅰb1期)子宫颈癌患者行不同方式的宫颈广泛性切除术(RT)后的安全性和生育情况,并分析其复发的相关因素.方法选择2004年5月至2012年7月间在中南大学湘雅医学院附属肿瘤医院行RT的32例年轻(＜40岁)的早期宫颈癌患者的临床资料.根据手术方式的不同将32例患者分为两组:行阴式RT(RVT)+腹腔镜下盆腔淋巴结切除术(RVT组),共18例；行腹式RT(RAT)+盆腔淋巴结切除术(RAT组),共14例.采用t检验或x2检验,对两组患者的术中、术后及生育情况进行比较；采用单因素方差分析和多因素Cox逐步回归法,对早期宫颈癌患者复发的相关因素进行分析.结果 RVT组患者的手术时间、淋巴结切除数、宫颈切除长度、术后住院时间、血管损伤发生率及术后淋巴囊肿发生率分别为(250±82) min、(15±6)个、(2.31±0.21) cm、(9.2±2.9)d、1/18、1/18,RAT组患者分别为(263 ±60) min、(16±8)个、(2.32±0.26) cm、(10.3±3.5)d、0、1/14,两组间分别比较,差异均无统计学意义(P＞0.05)；RVT组患者的术中出血量[(281 ±201) ml]明显低于RAT组[(492 ±320) ml；P＜0.05],阴道切除长度及宫旁组织切除宽度[分别为(2.61±0.50)、(2.38 ±0.36) cm]均明显小于RAT组[分别为(2.95±0.10)、(2.81 ±0.22) cm；P＜0.05]；血管损伤发生率(1/18)明显高于RAT组(0,P＜0.05).RVT组和RAT组患者术后的妊娠率分别为3/18、2/14,两组比较,差异无统计学意义(P＞0.05).单因素分析显示,早期宫颈癌患者的复发与肿瘤直径有关(F=4.911,P=0.047),而与年龄、临床分期、病理类型、手术方式无关(P＞0.05)；多因素分析显示,肿瘤直径是早期宫颈癌患者复发的独立危险因素(β=0.259,P =0.031).结论对年轻的早期宫颈癌患者实施保留生育功能的RT手术是可行的,RT术后的妊娠结局仍需大样本的研究证实.肿瘤直径是肿瘤复发的主要危险因素.
목적 탐토년경적조기(Ⅰa1～ Ⅰb1기)자궁경암환자행불동방식적궁경엄범성절제술(RT)후적안전성화생육정황,병분석기복발적상관인소.방법 선택2004년5월지2012년7월간재중남대학상아의학원부속종류의원행RT적32례년경(＜40세)적조기궁경암환자적림상자료.근거수술방식적불동장32례환자분위량조:행음식RT(RVT)+복강경하분강림파결절제술(RVT조),공18례；행복식RT(RAT)+분강림파결절제술(RAT조),공14례.채용t검험혹x2검험,대량조환자적술중、술후급생육정황진행비교；채용단인소방차분석화다인소Cox축보회귀법,대조기궁경암환자복발적상관인소진행분석.결과 RVT조환자적수술시간、림파결절제수、궁경절제장도、술후주원시간、혈관손상발생솔급술후림파낭종발생솔분별위(250±82) min、(15±6)개、(2.31±0.21) cm、(9.2±2.9)d、1/18、1/18,RAT조환자분별위(263 ±60) min、(16±8)개、(2.32±0.26) cm、(10.3±3.5)d、0、1/14,량조간분별비교,차이균무통계학의의(P＞0.05)；RVT조환자적술중출혈량[(281 ±201) ml]명현저우RAT조[(492 ±320) ml；P＜0.05],음도절제장도급궁방조직절제관도[분별위(2.61±0.50)、(2.38 ±0.36) cm]균명현소우RAT조[분별위(2.95±0.10)、(2.81 ±0.22) cm；P＜0.05]；혈관손상발생솔(1/18)명현고우RAT조(0,P＜0.05).RVT조화RAT조환자술후적임신솔분별위3/18、2/14,량조비교,차이무통계학의의(P＞0.05).단인소분석현시,조기궁경암환자적복발여종류직경유관(F=4.911,P=0.047),이여년령、림상분기、병리류형、수술방식무관(P＞0.05)；다인소분석현시,종류직경시조기궁경암환자복발적독립위험인소(β=0.259,P =0.031).결론 대년경적조기궁경암환자실시보류생육공능적RT수술시가행적,RT술후적임신결국잉수대양본적연구증실.종류직경시종류복발적주요위험인소.
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 Thirty-two young patients ＜ 40 years of age with early cervical cancer from May 2004 to July 2012 admitted in Tumor Hospital Xiangya School of Medicine of Central South University were divided into two groups based on different operation methods:vaginal radical trachelectomy (RVT) group and abdominal radical trachelectomy (RAT) group.The clinical data were analyzed by One-way Anova and multivariate Cox stepwise regression analysis.Results The operation duration,number of lymph node dissection,the height of the cervical resection,postoperative hospitalization time,incidence of vascular injury and incidence of postoperative lymphocele were respectively (250 ± 82) min,15 ± 6,(2.31 ± 0.21) cm,(9.2 ± 2.9) d,1/18 and 1/18 in RVT group,while (263 ±60) min,16 ±8,(2.32 ±0.26) cm,(10.3 ±3.5) d,0 and 1/14 in RAT group.There was no statistically significant difference between the two groups (all P ＞ 0.05).The blood loss (281 ±201) ml in RVT group was significantly lower than that in the RAT group (492 ±320) ml (P ＜0.05).The length of Vaginal hysterectomy[(2.61 ±0.50) cm] and the width of parametrial resection[(2.38 ±0.36) cm] in RVT group were significantly less than those[(2.95 ±0.10),(2.81 ±0.22) cm] in the RAT group (all P ＜ 0.05).The pregnancy rate between RVT group (3/18) and RAT group (2/14) were no significant difference (P ＞ 0.05).One-way Anova analysis showed that the recurrence of early cervical cancer was related to tumor size in diameter (F =4.911,P =0.047),while there were no correlation with age,clinical stage,histological type and surgical approach (all P ＞ 0.05).Multivariate analysis showed that tumor diameter size was an independent risk factor for tumor recurrence (3 =0.259,P =0.031).Conclusions RT for young patients with early cervical cancer is feasible.Pregnancy outcomes after RT need to be study in the future.Tumor size in diameter is the major risk factor for tumor recurrence.