早期宫颈癌根治性子宫切除术腹主动脉旁淋巴清扫必要性研究

Study on the extent of surgery of radical hysterectomy for early stage of cervical cancer

目的为缩小早期宫颈癌手术范围提供进一步的临床支持。方法收集2007年1月至2011年12月在北京协和医院进行宫颈癌手术治疗的早期宫颈癌患者122例，采用Kaplan—Meier方法和卡方检验进行生存分析和生存率差异的检测。患者平均年龄44．1（23～66）岁，其中97例（79．5％）未绝经患者。按2009年FIGO分期：IA2期3例，IB1期72例，IB2期26例，ⅡA期21例。病理类型：鳞癌106例（86．9％），腺癌13例（10．7％），腺鳞癌1例（0．8％），透明细胞癌1例（0．8％），小细胞癌1例（0．8％）。平均手术时间179．2（100—270）min，出血量458．2（50～1700）mL。结果122例患者中，盆腔淋巴结阳性者19例（15．6％），5例（4．1％）存在宫旁受累。68例同时实施了腹主动脉旁淋巴（PALN）清扫的患者中，2例（2．9％）为淋巴结阳性。术后发生并发症者35例（28．7％），其中淋巴潴留囊肿25例；肠梗阻11例。122例患者的平均随访时间31（5～67）个月，总生存率为97．5％。按照是否接受PALN清扫分组进行生存分析，结果对生存率影响差异无统计学意义（P=0．137）。结论早期子宫颈癌（IA2～ⅡA期）行根治性子宫切除术者是否行腹主动脉旁淋巴清扫对术后生存率的影响无差异。

Objective To provide further clinical support for reducing the extent of surgical resection of cervical cancer. Methods Between January 2007 and December 2011,122 cases who underwent radical hysterectomy in Peking Union Medical College Hospital with early cervical cancer were randomly selected in this study. Data was analyzed by using the Kaplan-Meier method and the chi-square test was used for detecting the difference in survival. The mean age of 122 pa- tients was 44. 1 （23 - 26） year, of which 97 （79.5%） were premenopausal women. In accordance with the FIGO （2009） ,3 cases had stage I A2,72 had stage I B1,26 had stage I B2, and 21 had stage IIA. 106 （86. 9% ） patients had squamous cell carcinoma, 13 had adenocarcinoma,and 1 had adenosquamous carcinoma, clear cell carcinoma and small cell carcinoma, respectively. The mean time of surgery was 179.2 （ 100 - 270） rains, the mean volume of blood loss was 458.2 （50 - 1700） mL. Results 19 of 122 （ 15.6% ） patients had positive pelvic lymph node and 5 cases （4. 1% ） had parametrial involvement. In the 68 patients who underwent paraaortic lymphadenectomy, only two were de- tected with positive lymph nodes. Postoperative complications occurred in 35 cases, 25 cases of lymphoeele and 11 cases of intestinal obstruction. All the patients with an average follow-up time of 31 （5 ~ 67 ） months, the overall survival rate was 97. 5%. The survival analysis showed that there was no significant improvement in survival for patients who under- went paraaortic lymphadeneetomy （P = 0. 137 ）. Conclusion The extent of surgical resection for early cervical cancer must be carefully considered. Paraaortic lymphadenectomy can not significantly affect the survival rates.