保留子宫切除术对年轻早期宫颈癌患者预后的影响

The Prognosis on Young Patients with Early-stage Cervical Cancer after Undergoing Fertility-sparing Treatments

目的探讨保留子宫切除术对年轻早期宫颈癌患者生育功能及预后的影响。方法选择28例行全腹腔镜广泛宫颈切除术(radical trachelectomy,RT)的早期宫颈癌患者作为观察组;选择同期31例行腹腔镜下子宫广泛性切除术(radical hysterectomy,RH)的早期宫颈癌患者作为对照组。比较2组患者术后标本检查的相关指标、术后生育情况以及术后随访情况。结果①观察组28例患者中,顺利完成保留生育功能手术的有27例,因术中快速冰冻,病理检查阳性,1例改行腹腔镜下RH。②2组切除的宫骶韧带长度、主韧带长度、阴道长度,切除的盆腔淋巴结数相比,差异均无统计学意义(P> 0. 05)。③术后的生育情况:观察组成功保留生育功能的27例患者中,有妊娠愿望的患者仅15例,其中妊娠6例,包括早产2例、自然流产1例、足月分娩3例。④术后的随访情况:对照组术后平均随访时间为30. 1个月,复发率3. 22%;观察组术后平均随访时间为29. 3个月,复发率3. 85%。2组患者复发率进行比较,差异无统计学意义(P>0. 05)。结论年轻早期宫颈癌患者行腹腔镜下RT手术,安全有效,且复发率较低,但其妊娠结局有待进一步的改善。

Objective To explore the outcomes of the oncology,the fertility and prognosis on young patients with early-stage cervical cancer after undergoing fertility-sparing treatments.Methods A total of 28 patients with cervical cancer(stageⅠa2~Ⅰb1)who had undergone total laparoscopic RT in our hospital were chosen as the observation group.A total of 31 patients with cervical cancer(stageⅠa2~Ⅰb1)who had undergone total laparoscopic RH in our hospital from August 2011 to September 2015 were chosen as the control group.The postoperative specimen examination,fertility after surgery and follow-up results were compared between the two groups.Results①Among these 28 patients in the observation group,quick frozen pathological examinations were positive in 1 cases,which underwent total laparoscopic RH eventually.②compared with the observation group and the control group,P >0.05,there were no significant difference in number of length of removed uterosacral ligament,length of removed cardinal ligament,length of removed vaginal,removed lymphatic nodes,(P >0.05).③Fertility after surgery results:in the observation group,only 15 patients had fertility requirement after treatments.Pregnancies occurred in 6 women,which included,2 case of preterm labor,1 cases of spontaneous abortion and 3 case of full-term labor.④Postoperative tumor follow-up results:The average follow-up time in postoperative patients of the control group was 30.1,and 29.3 months in the observation group.In follow-up period,compare with the control group and the observation group,P >0.05,there was no significant difference in the recurrence rate(3.22%,3.85%)(P >0.05).Conclusion total laparoscopic RT on young patients with early-stage cervical cancer was safe,the recurrence rate is low,but the outcome of the pregnancy is still need to improve.