腹腔镜下保留生育功能宫颈癌根治术治疗早期子宫颈癌的近期临床疗效

Short-term Clinical Outcomes of Laparoscopic Fertility-preserving Radical Hysterectomy in the Management of Early-stage Cervical Cancer

目的探讨腹腔镜下根治性子宫颈切除术和盆腔淋巴结切除术治疗早期子宫颈癌的可行性和效果。方法回顾分析6例Ⅰa2～Ⅰb1期行腹腔镜下保留生育功能子宫颈癌根治术患者的临床资料,分析手术时间、出血量、手术后病理、并发症、妊娠情况等。结果根治性子宫颈切除术和盆腔淋巴结清扫术均在腹腔镜下完成,仅宫颈和阴道断端缝合经阴道完成。手术时间155～210 min,平均185 min;术中出血量约60～120 ml,平均105 ml。术中及术后均无并发症。术后病理学检查未见淋巴结癌转移,癌细胞未侵及韧带、脉管、阴道切缘和宫颈上端。随访8～20个月,1例患者妊娠4个月,无1例肿瘤复发。结论对于未生育且强烈要求保留生育功能的早期子宫颈癌患者,在腹腔镜下行根治性子宫颈切除术和盆腔淋巴结切除术是可行的。

Objective To investigate the feasibility and effectiveness of laparoscopic radical trachelectomy and lymphadenectomy in the treatment of early-stage cervical cancer.Methods The clinical data of 6 patients（stageⅠa2 to Ⅰb1）,who underwent laparoscopic fertility-preserving radical operation for cervical cancer in our department from February 2009 to October 2010,were retrospectively analyzed in terms of operation duration,intra-operative blood loss,postoperative pathology,complications,and pregnancy.Results Both radical resection of cervical and pelvic lymph node dissection were completed under laparoscopy,and only the cervical and vaginal cuffs were closed from vagina.The operation duration ranged 155-210 min（mean： 185 min） and the intra-operative blood loss was approximately 60-120 ml（mean： 105 ml）.The average length of hospital stay was 18 days without complications,postoperative infection,and bleeding.Postoperative pathology showed no lymph node metastasis,and no ligament,blood vessels,vaginal cutting margin,or upper part of cervix was invaded by tumor cells.During the 8-20-month follow-up,1 patient had become pregnant for 4 months and no case experienced tumor recurrence.Conclusion Laparoscopic fertility-preserving lymphadenectomy and radical trachelectomy is feasible for patients with early-stage cervical cancer who have strong wish to have a child.