阴式子宫颈广泛切除术在治疗早期宫颈癌及保留生育功能中的作用

Effect of vaginal radical trachelectomy in treating the early cervical cancer and preserving fertility

目的:探讨早期宫颈癌患者行阴式子宫颈广泛切除术(VRT)的治疗效果及生育结局。方法:采用VRT联合腹腔镜盆腔淋巴结切除术治疗早期宫颈癌50例,其中2例患者因盆腔淋巴结受累及子宫颈内口切缘受累终止手术改行同步放化疗。结果:48例患者成功完成VRT手术,手术时间(185±35)min;术中出血量(310±131)ml。手术切除的子宫颈长度为(2.6±0.6)cm;子宫旁组织宽度为(1.9±0.5)cm;切除的淋巴结数为(26±10)枚;随访(35±21)个月,随访期内6例复发,复发率为12.5%,中位复发时间为20个月。其中,肿瘤>2 cm 8例中复发3例,高于肿瘤≤2 cm患者的7.5%(P=0.0497);腺癌或腺鳞癌患者复发3例,高于鳞癌患者的7.1%(P=0.019 8);随访≥6个月且有生育要求者35例,其中13例患者获妊娠17例次,妊娠率为37.1%;有9例患者分娩10名新生儿(其中1例患者先后两次足月分娩),生育率25.7%。结论:VRT联合腹腔镜盆腔淋巴结切除术能有效保留早期宫颈癌患者的生育功能,肿瘤>2 cm患者易复发,因而VRT的适应证应严格限于肿瘤≤2 cm的患者。

Objective：To explore the effects of vaginal radical trachelectomy （ VRT ） in treating the early cervical cancer and preserving fertility of patients. Methods：Fifty patients with the early cervical cancer were treated with VRT combined with laparoscopic pelvic lymph node resection. Among the patients,2 cases with pelvic lymph node and cervical margin involvement were treated with synchronized chemoradiotherapy. Results：Among 48 patients,all VRT operations were successful,the operation time and peroperative bleeding were（185 ± 35） min and（310 ± 131） ml,respectively. The cervical length and parametrium width of surgical excision were （2. 6 ± 0. 6） cm and（1. 9 ± 0. 5） cm,respectively. The number of lymph node excision was（26 ± 10）. The patients were followed up for（35 ± 21） months. Six cases recurred during the following up period,the recurrence rate of which was 12. 5%. The recurrence median time was 20 months. Three cases in 8 cases with tumor size more than 2 cm recurred,which was significantly higher than that in the patients with tumor size equal to or less than 2 cm（7. 5%,P=0. 049 7）. Three cases with cadenocarcinoma or adenosquamous carcinoma recurred,the recurrence rate of which was higher than that in 7. 1% of patients with squamous carcinoma（P=0. 0198）. During the equaal to or more than 6 months of following-up,35 patients desired to give birth to,13 women conceived 17 times,the pregnant rate of which was 37. 1%. Nine women given birth to 10 newborns babies （ 1 cases conceived 2 times and were normal delivery）,the fertility rate of which was 25. 7%. Conclusions：VRT combined with laparoscopic pelvic lymph node resection can effectively preserve the fertility of patients with early cervical cancer. The patients with tumor size equal to or less than 2 cm are easy to recur,the indication of VRT should be strictly limited to the patients with tumor size equal to or less than 2 cm.