年轻早期宫颈癌患者行不同入路广泛性宫颈切除术的预后情况及复发影响因素探讨

Analysis of the security,pregnancy outcomes,and the tumor recurrence related factors of young patients with cervical cancer treated with different radical trachelectomy

目的 分析年轻早期（ⅠA1～ⅠB1期）宫颈癌患者行不同入路广泛性宫颈切除术（RT）的预后情况及复发影响因素.方法 回顾性分析82例行RT年轻（＜40岁）早期宫颈癌患者的临床资料.根据不同手术入路分为两组：行腹式RT（ART）加盆腔淋巴结切除术39例（ART组）,阴式RT（VRT）加腹腔镜下盆腔淋巴结切除术43例（VRT组）.比较两组术中、术后和生育情况,对影响复发的临床因素采用单因素方差及多因素Cox逐步回归进行分析.结果 两组淋巴结切除数、手术时间、术后住院时间、宫颈切除长度、术后并发症发生率、术后妊娠率比较差异均无统计学意义（P＞ 0.05）;VRT组术中出血量、阴道切除长度、宫旁组织切除宽度均明显小于ART组[（282.7±201.0） ml比（429.4±320.8） ml、（2.42±0.51） cm比（2.98±0.11） cm、（2.39±0.37） cm比（2.82±0.23） cm],差异有统计学意义（P＜0.05）.单因素方差分析结果显示,早期宫颈癌复发与年龄、病理类型、临床分期、手术方式无关（P＞0.05）,而与肿瘤直径有关（P＜0.05）.多因素Cox逐步回归分析结果显示,肿瘤直径是影响到早期宫颈癌患者复发的独立危险因素（β=0.248,95％ CI0.077～0.882,P=0.032）.结论 对于年轻早期宫颈癌患者实施保留生育功能的RT是可行的,VRT略优于ART,但术后妊娠结局需大样本量进一步证实,肿瘤直径是年轻早期宫颈癌患者复发重要且独立危险因素.

Objective To explore the security,pregnancy outcomes,and the tumor recurrence related factors of young patients with cervical cancer treated with different radical trachelectomy （RT）.Methods Eighty-two young patients （〈 40 years） with early cervical cancer were divided into two groups based on different operation methods：vaginal radical trachelectomy （VRT） group of 43 cases and abdominal radical trachelectomy （ART） group of 39 cases.The clinical data were analyzed retrospectively,One-way Anova and Multivariate Cox Stepwise Regression analysis were used.Results The number of lymph node dissection,operation duration,postoperative hospitalization time,height of the cervical resection,incidence of postoperative complications,the postoperative pregnancy rate were no statistically significant difference between two groups（P 〉 0.05）.The blood loss,length of vaginal hysterectomy,width of parametrial resection in VRT group were significantly less than those in ART group[（282.7 ± 201.0） ml vs.（429.4 ± 320.8） ml,（2.42 ± 0.51） cm vs.（2.98 ± 0.11） cm,（2.39 ± 0.37） cm vs.（2.82 ± 0.23） cm] （P 〈 0.05）.One-way Anova analysis showed that the recurrence of early cervical cancer was related to tumor diameter size （P 〈 0.05）,while there were no correlation with age,clinical stage,histological type and surgical approach （P 〉 0.05）.Multivariate Cox Stepwise Regression analysis showed that tumor diameter size was an independent risk factor for tumor recurrence（β =0.248,95% CI 0.077-0.882,P =0.032）.Conclusions RT for young patients with early cervical cancer is feasible.Pregnancy outcomes after RT need to be studied in the future.Tumor size in diameter is the major risk factor for tumor recurrence.