Ⅰ型子宫切除术用于ⅠA期子宫颈癌的可行性研究

Feasibility study of type Ⅰ hysterectomy in stage Ⅰ A cervical cancer

目的 比较子宫颈癌ⅠA期采用Ⅰ型和Ⅱ型子宫切除术的疗效及并发症,探索Ⅰ型子宫切除术用于ⅠA期子宫颈癌的可行性.方法 对92例子宫颈癌患者（48例ⅠA1期,44例ⅠA2期）行Ⅰ型子宫切除术加选择性盆腔淋巴结切除（研究组）,对93例子宫颈癌患者（49例ⅠA1期,44例ⅠA2期）行Ⅱ型子宫切除术加选择性盆腔淋巴结切除（对照组）.结果 研究组5年和10年生存率分别为100 ％（92/92）、100％（74/74）,对照组分别为100 ％（93/93）、100％（66/66）.研究组泌尿道感染率为0（0/92）,低于对照组的13.99％（13/93）（P＜0.05）.研究组的手术时间、出血量和人均输血量分别为（96.14±17.20）min、（117.35±39.61）ml和0 ml,均较对照组[（116.82±16.30）min、（201.74±46.25） ml、（82.07±16.32） ml]减少,差异均有统计学意义（P＜0.01）.结论 子宫颈癌ⅠA期患者采用Ⅰ型和Ⅱ型子宫切除术的5年和10年生存率相当,但前者术后泌尿道感染率低于后者,且手术时间缩短,出血量和输血量均减少,其用于ⅠA期子宫颈癌是有效的、可行的.

Objective To compare the efficacy and complications of the two surgical methods （between type Ⅰ hysterectomy and type Ⅱ hysterectomy）,and to explore the feasibility of type Ⅰ hysterectomy in stage ⅠA cervical cancer.Methods The study group,92 cases（48 cases of stage ⅠA1,44 cases of stage ⅠA2） were performed with type Ⅰ hysterectomy plus selective pelvic lymph node dissection;the control group,93 cases （49 cases of stage ⅠA1,44 cases of ⅠA2） were performed with type Ⅱ hysterectomy plus selective pelvic lymph node dissection.Results The survival rate of 5 years and 10 years in study group were 100 % （92/92）,100 % （74/74） and that in control group were 100 % （93/93）,100 %（66/66）,respectively.There were no signicant difference between the two group （both P 〉 0.05）.When compared with the control group,the urinary tract infection of the study group was significantly reduced （0 versus 13.99 %,P 〈 0.05）.Moreover,there were a shorter surgical duration [（96.14±17.20） min vs （116.82±16.30） min].The hemorrhage [（117.35±39.61） ml] and blood transfusion （0 ml） in study group was less common than those in control group [（201.74±46.25） ml,（82.07±16.32） ml] （all P 〈 0.01）.Conclusion There are no difference of 5-year and l0-year survival rate in stage ⅠA patients with type Ⅰ or type Ⅱ hysterectomy,however,the rate of the postoperative urinary tract infection in the former is lower than that in the latter,and also there are a shorter surgical duration,less hemorrhage and reduced blood transfusion requirements in study group.Therefore,type Ⅰ hysterectomy can be effective and applicable for the patients of stage ⅠA cervical cancer.