保留子宫动脉上行支的全腹腔镜广泛宫颈切除术

Ascending branches of uterine arteries sparing total laparoscopic radical trachelectomy

目的探讨全腹腔镜广泛宫颈切除术(TLRT)和腹腔镜盆腔淋巴清扫术(LPL)治疗早期宫颈癌的可行性和临床效果。方法 2009年7月至2010年7月在广州医学院第三附属医院等3家医院,对3例FIGO分期ⅠA2期和1例ⅠB1期要求保留生育功能的宫颈癌患者施行LPL,术中快速病理检查证实无淋巴组织转移后,即行TLRT,术中保持子宫动脉上行支的完整性,切除宫颈、宫旁组织和阴道上段组织,环扎宫颈并端端缝合宫颈峡部和阴道断端,保留子宫体及双侧附件。结果 4例患者均成功地完成了LPL和TLRT,平均手术时间为285min,平均术中出血量为180mL;4例患者术中无泌尿道、肠道损伤和术中大出血等严重并发症发生,术后无感染及出血;1例患者术后第7天拔除尿管后出现膀胱功能障碍,经膀胱功能锻炼,8d后痊愈出院;随诊时间7～19个月,无一例肿瘤复发;4例患者均于术后第1个月恢复正常月经。结论 TLRT以其微创的优点为有保留生育功能要求的早期宫颈癌患者提供了一种安全有效的治疗手段。

Objective To evaluate the feasibility and therapeutic efficacy of total laparoscopic radical trachelectomy （ TL- RT） with ascending branches of uterine arteries preservation combined laparoscopic pelvic lymphadenectomy （LPL） in treating woman with early cancer who wish to preserve fertility. Methods Between July 2009 and July 2010 at the Third Affiliated Hospital of Guangzhou Medical College and other two Hospitals, TLRT combined with LPL were performed successfully for three stage I A2and one stage I BI cervical cancer patients who wished to retain fertility. Results Medial operative time （including the time of frozen section analysis） was 285 minutes, with mean blood loss 180mL, and average hospital stay of 15 days. No intraoperative complication occurred. Urinary retention occurred in one patient alter removing the bladder catheter on the 7th postoperative day. With performing catheterization again and training function of bladder, this patient achieved spontaneous urination after g days. During limited follow-up of 7 - 19 months, the menstrual pattern of all patients normalized. There was no evidence of recurrence, which was proved with gynecologic examination, ultrasound, magnetic resonance imaging and the smears of the vaginal vault and isthmus. Conclusion Although TLRT combined with LPL seems to be a useful alternative for women with early stage cervical cancer who want to preserve fertility, larger series of patients with longer follow-up are necessary for fully evaluating the therapeutic efficacy of TLRT.