蚌埠医学院学报
蚌埠醫學院學報
방부의학원학보
ACTA ACADEMIAE MEDICINAE BENGBU
2015年
9期
1178-1181
,共4页
子宫颈肿瘤%阴式子宫颈广泛切除术%生育功能
子宮頸腫瘤%陰式子宮頸廣汎切除術%生育功能
자궁경종류%음식자궁경엄범절제술%생육공능
cervical neoplasms%vaginal radical trachelectomy%fertility preservation
目的：：探讨早期宫颈癌患者行阴式子宫颈广泛切除术( VRT)的治疗效果及生育结局。方法：采用VRT联合腹腔镜盆腔淋巴结切除术治疗早期宫颈癌50例，其中2例患者因盆腔淋巴结受累及子宫颈内口切缘受累终止手术改行同步放化疗。结果：48例患者成功完成VRT手术，手术时间(185±35)min；术中出血量(310±131)ml。手术切除的子宫颈长度为(2.6±0.6)cm；子宫旁组织宽度为(1.9±0.5)cm；切除的淋巴结数为(26±10)枚；随访(35±21)个月，随访期内6例复发，复发率为12.5%，中位复发时间为20个月。其中，肿瘤>2 cm 8例中复发3例，高于肿瘤≤2 cm患者的7.5%(P=0.0497)；腺癌或腺鳞癌患者复发3例，高于鳞癌患者的7.1%(P=0.0198)；随访≥6个月且有生育要求者35例，其中13例患者获妊娠17例次，妊娠率为37.1%；有9例患者分娩10名新生儿(其中1例患者先后两次足月分娩)，生育率25.7%。结论：VRT联合腹腔镜盆腔淋巴结切除术能有效保留早期宫颈癌患者的生育功能，肿瘤>2 cm患者易复发，因而VRT的适应证应严格限于肿瘤≤2 cm的患者。
目的：：探討早期宮頸癌患者行陰式子宮頸廣汎切除術( VRT)的治療效果及生育結跼。方法：採用VRT聯閤腹腔鏡盆腔淋巴結切除術治療早期宮頸癌50例，其中2例患者因盆腔淋巴結受纍及子宮頸內口切緣受纍終止手術改行同步放化療。結果：48例患者成功完成VRT手術，手術時間(185±35)min；術中齣血量(310±131)ml。手術切除的子宮頸長度為(2.6±0.6)cm；子宮徬組織寬度為(1.9±0.5)cm；切除的淋巴結數為(26±10)枚；隨訪(35±21)箇月，隨訪期內6例複髮，複髮率為12.5%，中位複髮時間為20箇月。其中，腫瘤>2 cm 8例中複髮3例，高于腫瘤≤2 cm患者的7.5%(P=0.0497)；腺癌或腺鱗癌患者複髮3例，高于鱗癌患者的7.1%(P=0.0198)；隨訪≥6箇月且有生育要求者35例，其中13例患者穫妊娠17例次，妊娠率為37.1%；有9例患者分娩10名新生兒(其中1例患者先後兩次足月分娩)，生育率25.7%。結論：VRT聯閤腹腔鏡盆腔淋巴結切除術能有效保留早期宮頸癌患者的生育功能，腫瘤>2 cm患者易複髮，因而VRT的適應證應嚴格限于腫瘤≤2 cm的患者。
목적：：탐토조기궁경암환자행음식자궁경엄범절제술( VRT)적치료효과급생육결국。방법：채용VRT연합복강경분강림파결절제술치료조기궁경암50례，기중2례환자인분강림파결수루급자궁경내구절연수루종지수술개행동보방화료。결과：48례환자성공완성VRT수술，수술시간(185±35)min；술중출혈량(310±131)ml。수술절제적자궁경장도위(2.6±0.6)cm；자궁방조직관도위(1.9±0.5)cm；절제적림파결수위(26±10)매；수방(35±21)개월，수방기내6례복발，복발솔위12.5%，중위복발시간위20개월。기중，종류>2 cm 8례중복발3례，고우종류≤2 cm환자적7.5%(P=0.0497)；선암혹선린암환자복발3례，고우린암환자적7.1%(P=0.0198)；수방≥6개월차유생육요구자35례，기중13례환자획임신17례차，임신솔위37.1%；유9례환자분면10명신생인(기중1례환자선후량차족월분면)，생육솔25.7%。결론：VRT연합복강경분강림파결절제술능유효보류조기궁경암환자적생육공능，종류>2 cm환자역복발，인이VRT적괄응증응엄격한우종류≤2 cm적환자。
Objective:To explore the effects of vaginal radical trachelectomy ( VRT ) in treating the early cervical cancer and preserving fertility of patients. Methods:Fifty patients with the early cervical cancer were treated with VRT combined with laparoscopic pelvic lymph node resection. Among the patients,2 cases with pelvic lymph node and cervical margin involvement were treated with synchronized chemoradiotherapy. Results:Among 48 patients,all VRT operations were successful,the operation time and peroperative bleeding were(185 ± 35) min and(310 ± 131) ml,respectively. The cervical length and parametrium width of surgical excision were (2. 6 ± 0. 6) cm and(1. 9 ± 0. 5) cm,respectively. The number of lymph node excision was(26 ± 10). The patients were followed up for(35 ± 21) months. Six cases recurred during the following up period,the recurrence rate of which was 12. 5%. The recurrence median time was 20 months. Three cases in 8 cases with tumor size more than 2 cm recurred,which was significantly higher than that in the patients with tumor size equal to or less than 2 cm(7. 5%,P=0. 049 7). Three cases with cadenocarcinoma or adenosquamous carcinoma recurred,the recurrence rate of which was higher than that in 7. 1% of patients with squamous carcinoma(P=0. 0198). During the equaal to or more than 6 months of following-up,35 patients desired to give birth to,13 women conceived 17 times,the pregnant rate of which was 37. 1%. Nine women given birth to 10 newborns babies ( 1 cases conceived 2 times and were normal delivery),the fertility rate of which was 25. 7%. Conclusions:VRT combined with laparoscopic pelvic lymph node resection can effectively preserve the fertility of patients with early cervical cancer. The patients with tumor size equal to or less than 2 cm are easy to recur,the indication of VRT should be strictly limited to the patients with tumor size equal to or less than 2 cm.
