改良腹式与全腹腔镜广泛宫颈切除术治疗早期宫颈癌的比较

The Comparison between Modified Abdominal and Total Laparoscopic Trachelectomy for Patients with Early-Stage Cervical Cancer

目的:比较改良腹式广泛宫颈切除术(MART)与全腹腔镜广泛宫颈切除术(TLRT)在早期宫颈癌保留生育功能治疗中的技术异同性、临床治疗效果和妊娠结局。方法:收集2002年10月至2014年7月46例早期宫颈癌并接受MART或TLRT手术患者的临床资料和随访结果,并进行对比。结果:46例患者均完成预期手术,其中MART组27例,TLRT组19例。TLRT组术中出血量及住院时间明显少于MART组(P<0.05),MART组在手术时间、切除宫旁组织长度、子宫动脉损伤率方面明显优于TLRT组(P<0.05)。两组切除淋巴结数、腹腔引流量及膀胱功能障碍发生率等比较,差异无统计学意义(P>0.05)。术后随访两组均无复发,MART组妊娠率(38.10%)与TLRT组(53.85%)比较,差异无统计学意义(P>0.05)。结论:MART和TLRT两种手术方式均可有效治疗早期宫颈癌并实现患者保留生育功能的愿望。MART术式切除宫旁范围较TLRT相对较广,TLRT在减少术中出血及对盆腔脏器的干扰方面有其微创的优势。选择手术方式应个体化。

Objective： To compare the technical variability, clinical efficacy and reproductive outcome on pa- tients with early-stage cervical cancer between total laparoscopic trachelectomy and modified abdominal radical trachelectomy. Methods：We retrospectively collected the cases of patients with early-stage cervical cancer in four hospitals from October 2012 to July 2014. All these patients had either undergone total laparoscopic radical tra- chelectomy（TLRT） or modified abdominal radical trachelectomy（MART） in a standardized manner by the same surgeons. The clinical data and the follow up results of these cases were analyzed. Results ：46 patients received RT in all,including 27 MART and 19 TLRT. TLRT was associated with less blood loss, hospitalization days（ P 〈 0.05）. MART presented less probability of urterine artery injure and less operating time（ P 〈 0.05）. Difference of median harvested lymph nodes, postoperative abdominal drainage and the incidence of bladder hypotonia was not found between these two groups（ P 〉 0. 05）. According to the follow up,there was no recurrence of the disease in both groups. There was no significantly difference on the pregnancy rate between MART group（38. 10% ）and TL- RT group（53.85% ） （ P 〉 0. 05）. Conclusions. TLRL and MART have similar therapeutic efficacy and both can preserve fertilization of the early-stage cervical cancer patients. MART is of potential benefit for patients with the larger nidus,TLRT was superior in deceasing blood loss and protecting the pelvic organ during the surgery. We should make the surgery program individually considering the characteristics of these two methods.