中华妇幼临床医学杂志（电子版）
中華婦幼臨床醫學雜誌（電子版）
중화부유림상의학잡지（전자판）
CHINESE JOURNAL OF OBSTETRICS & GYNECOLOGY AND PEDIATRICS(ELECTRONIC VERSION)
2015年
4期
480-484
,共5页
阴式子宫颈广泛切除术%宫颈癌%保留生育能力
陰式子宮頸廣汎切除術%宮頸癌%保留生育能力
음식자궁경엄범절제술%궁경암%보류생육능력
Vaginal radical trachelectomy%Cervical cancer%Fertility preservation
目的：探讨对早期宫颈癌患者进行阴式子宫颈广泛切除术(VRT)的临床疗效及生育结局。方法选择2008年1月至2014年3月于湖北省黄石市妇幼保健院接受 VRT 联合腹腔镜盆腔淋巴结切除术治疗的早期宫颈癌患者48例为研究对象。48例患者的中位年龄为29岁；国际妇产科联盟(FIGO)临床分期：ⅠA1期伴淋巴血管间隙受累为5例,ⅠA2期为4例,ⅠB1期为39例；肿瘤直径：无肉眼可见肿瘤为20例,肿瘤直径≤2 cm 为20例,>2 cm 为 8例；病理类型：鳞癌为42例,腺癌或腺鳞癌为6例。排除因盆腔淋巴结受累或子宫颈内口切缘受累,于 VRT 中改行同步放、化疗者。采用回顾性分析法分析48例成功完成 VRT 患者的手术相关指标、治疗效果及生育结局。本研究遵循的程序符合湖北省黄石市妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与受试者签署临床研究知情同意书。结果①手术相关结果：对48例患者均成功施行 VRT 而保留生育功能,手术平均时间为(185±35)min；术中平均出血量为(310±131)mL。手术切除的子宫颈平均长度为(2.6±0.6)cm；切除的宫旁组织平均宽度为(1.9±0.5)cm；平均切除淋巴结数为(26±10)枚。②治疗效果：VRT 后随访期内6例复发,复发率为12%(6/48),复发中位时间为20个月。肿瘤直径>2 cm 者的复发率显著高于肿瘤直径≤2 cm 者,差异有统计学意义(37.5% vs 8.0%,χ2=12.52,P <0.01)；腺癌或腺鳞癌患者的复发率显著高于鳞癌患者,差异有统计学意义(50% vs 7%,χ2=18.66,P <0.01)。③生育结局：VRT 后有生育要求的35例患者中,13例获妊娠17例次,妊娠率为37%(13/35)；9例受试者最终分娩10例新生儿(1例2次足月妊娠并成功分娩 2例新生儿),生育率为26%(9/35)。结论VRT 联合腹腔镜盆腔淋巴结切除术,可有效保留早期子宫颈癌患者生育功能,部分患者术后可成功妊娠并生育。肿瘤直径>2 cm 早期子宫颈癌患者的复发率显著增高,因而 VRT 的适应证应严格限于肿瘤直径≤2 cm 者。
目的：探討對早期宮頸癌患者進行陰式子宮頸廣汎切除術(VRT)的臨床療效及生育結跼。方法選擇2008年1月至2014年3月于湖北省黃石市婦幼保健院接受 VRT 聯閤腹腔鏡盆腔淋巴結切除術治療的早期宮頸癌患者48例為研究對象。48例患者的中位年齡為29歲；國際婦產科聯盟(FIGO)臨床分期：ⅠA1期伴淋巴血管間隙受纍為5例,ⅠA2期為4例,ⅠB1期為39例；腫瘤直徑：無肉眼可見腫瘤為20例,腫瘤直徑≤2 cm 為20例,>2 cm 為 8例；病理類型：鱗癌為42例,腺癌或腺鱗癌為6例。排除因盆腔淋巴結受纍或子宮頸內口切緣受纍,于 VRT 中改行同步放、化療者。採用迴顧性分析法分析48例成功完成 VRT 患者的手術相關指標、治療效果及生育結跼。本研究遵循的程序符閤湖北省黃石市婦幼保健院人體試驗委員會所製定的倫理學標準,得到該委員會批準,併與受試者籤署臨床研究知情同意書。結果①手術相關結果：對48例患者均成功施行 VRT 而保留生育功能,手術平均時間為(185±35)min；術中平均齣血量為(310±131)mL。手術切除的子宮頸平均長度為(2.6±0.6)cm；切除的宮徬組織平均寬度為(1.9±0.5)cm；平均切除淋巴結數為(26±10)枚。②治療效果：VRT 後隨訪期內6例複髮,複髮率為12%(6/48),複髮中位時間為20箇月。腫瘤直徑>2 cm 者的複髮率顯著高于腫瘤直徑≤2 cm 者,差異有統計學意義(37.5% vs 8.0%,χ2=12.52,P <0.01)；腺癌或腺鱗癌患者的複髮率顯著高于鱗癌患者,差異有統計學意義(50% vs 7%,χ2=18.66,P <0.01)。③生育結跼：VRT 後有生育要求的35例患者中,13例穫妊娠17例次,妊娠率為37%(13/35)；9例受試者最終分娩10例新生兒(1例2次足月妊娠併成功分娩 2例新生兒),生育率為26%(9/35)。結論VRT 聯閤腹腔鏡盆腔淋巴結切除術,可有效保留早期子宮頸癌患者生育功能,部分患者術後可成功妊娠併生育。腫瘤直徑>2 cm 早期子宮頸癌患者的複髮率顯著增高,因而 VRT 的適應證應嚴格限于腫瘤直徑≤2 cm 者。
목적：탐토대조기궁경암환자진행음식자궁경엄범절제술(VRT)적림상료효급생육결국。방법선택2008년1월지2014년3월우호북성황석시부유보건원접수 VRT 연합복강경분강림파결절제술치료적조기궁경암환자48례위연구대상。48례환자적중위년령위29세；국제부산과련맹(FIGO)림상분기：ⅠA1기반림파혈관간극수루위5례,ⅠA2기위4례,ⅠB1기위39례；종류직경：무육안가견종류위20례,종류직경≤2 cm 위20례,>2 cm 위 8례；병리류형：린암위42례,선암혹선린암위6례。배제인분강림파결수루혹자궁경내구절연수루,우 VRT 중개행동보방、화료자。채용회고성분석법분석48례성공완성 VRT 환자적수술상관지표、치료효과급생육결국。본연구준순적정서부합호북성황석시부유보건원인체시험위원회소제정적윤리학표준,득도해위원회비준,병여수시자첨서림상연구지정동의서。결과①수술상관결과：대48례환자균성공시행 VRT 이보류생육공능,수술평균시간위(185±35)min；술중평균출혈량위(310±131)mL。수술절제적자궁경평균장도위(2.6±0.6)cm；절제적궁방조직평균관도위(1.9±0.5)cm；평균절제림파결수위(26±10)매。②치료효과：VRT 후수방기내6례복발,복발솔위12%(6/48),복발중위시간위20개월。종류직경>2 cm 자적복발솔현저고우종류직경≤2 cm 자,차이유통계학의의(37.5% vs 8.0%,χ2=12.52,P <0.01)；선암혹선린암환자적복발솔현저고우린암환자,차이유통계학의의(50% vs 7%,χ2=18.66,P <0.01)。③생육결국：VRT 후유생육요구적35례환자중,13례획임신17례차,임신솔위37%(13/35)；9례수시자최종분면10례신생인(1례2차족월임신병성공분면 2례신생인),생육솔위26%(9/35)。결론VRT 연합복강경분강림파결절제술,가유효보류조기자궁경암환자생육공능,부분환자술후가성공임신병생육。종류직경>2 cm 조기자궁경암환자적복발솔현저증고,인이 VRT 적괄응증응엄격한우종류직경≤2 cm 자。
Objective To study prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy (VRT)in combination with laparoscopic pelvic lymphadenectomy.Methods From January 2008 to March 2013,a total of 48 cases of early cervical cancer patients who received VRT in Huangshi Maternal and Child Health Care Hospital were selected as study subjects.Their median age was 29 years.According to the International Federation of Gynecology and Obstetrics (FIGO)stage of cervical cancer,5 cases of them were in stage of ⅠA1 ,4 cases were in stage ofⅠA2 ,and 39 cases were in stage of ⅠB1 .Among them 20 cases′cervical cancer were not visible to the naked eye,20 cases′diameters of cervical cancer were equal or less than 2 cm,8 cases were more than 2 cm. Pathological types of cervical cancer in this group,42 cases were squamous cell carcinoma,and 6 cases were adenocarcinoma or adenocarcinoma. Pelvic node involvement or the cervical internal jugular margin involvement were excluded.By retrospectively method,the surgical data,disease recurrences and fertility outcomes of 48 cases of early cervical cancer patients were statistically analyzed.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Huangshi Maternal and Child Health Care Hospital in Hubei Province. Informed consent was obtained from all participants. Results ①Forty-eight patients succeeded in preserving fertility by VRT.The mean duration of VRT was (185±35)min,intraoperative mean blood loss volume was (310 ± 131 )mL.The mean excised cervical length and parametrial width was (2.6 ± 0.6 )cm and (1.9 ± 0.5 )cm,respectively.② Six recurrences (12%)were observed after following up for a mean duration of (35 ± 21 )months.The recurrent rate in patients with tumor diameter>2 cm was significantly higher than that of the patients with tumor diameter ≤2 cm (37.5% vs 8.0%,χ2 =12.52,P <0.01)and the difference was significantly different.The recurrent rate in patients with adenocarcinoma or squamous cell carcinoma was significantly higher than that of the patients with cervical squamous cell carcinoma (50% vs 7%,χ2 =18.66,P <0.01)and the difference was significantly different.③Among the 35 patients who desired to conceive after the surgery,13 women had 1 7 pregnancies and the pregnant rate was 37.1% (13/35).Nine women obtained 10 healthy live birth babies. The fertility rate was 25.7% (9/35 ). Conclusions VRT combined with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes.Tumor diameter ≤2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor diameter >2 cm.
