不同手术方式对肿瘤直径小于2cm年轻有生育需求的早期宫颈癌患者妊娠结局及复发率的影响

Effect of different surgical methods on pregnancy outcome and early recurrence rate in patients with reproductive needs and diameter of cervical tumors less than 2cm

目的探讨不同手术方式对肿瘤直径<2cm年轻有生育需求的早期宫颈癌患者妊娠结局和复发率的影响。方法选取2012年1月至2017年1月间西安大兴医院收治的92例肿瘤直径<2cm有生育需求的早期宫颈癌患者,采用随机数表法分为研究组和对照组,每组46例。研究组患者行阴式宫颈广泛切除术+腹腔镜下盆腔淋巴结切除术,对照组患者行经腹式宫颈广泛切除术+盆腔淋巴结切除术,比较两组患者的妊娠结局,随访2年调查宫颈癌复发情况。结果两组患者手术时间、淋巴结切除个数、宫颈切除长度和住院时间比较,差异无统计学意义(P> 0. 05);研究组患者术中出血量、宫旁组织切除宽度和阴道切除长度等指标均少于对照组,差异均有统计学意义(均P <0. 05)。随访两年,研究组患者妊娠率为82. 6%,高于对照组的65. 2%,不良妊娠结局10. 5%,低于对照组的36. 7%,组间比较,差异均有统计学意义(均P <0. 05)。两组患者复发率、致死率和患者满意率比较,差异无统计学意义(P> 0. 05)。结论肿瘤直径<2cm年轻有生育需求的患者行阴式宫颈广泛切除术+腹腔镜下盆腔淋巴结切除术,治疗效果优于经腹式宫颈广泛切除术+盆腔淋巴结切除术,临床可根据患者具体病情选择合适的手术进行治疗。

Objective To investigate the effect of different surgical methods on pregnancy outcome and early recurrence rate in patients with reproductive needs and diameter of cervical tumors less than 2 cm.Methods A total of 92 patients with early cervical cancer at Xi’an Daxing Hospital with a tumor diameter <2 cm in diameter from January 2012 to January 2017 were selected and randomly divided into a study group and a control group according to random number table method with 46 patients in each group. The vaginal cervical resection and laparoscopic pelvic lymphadenectomy were performed in the study group. The control group underwent transabdominal cervical resection and pelvic lymphadenectomy. The pregnancy outcomes and the recurrence of cervical cancer were investigated after 2 years of follow-up. Results There was no significant difference in the operation time,number of lymph node resection,length of cervical resection and length of hospital stay between the two groups( P > 0. 05). The intraoperative blood loss,the width of parametrial resection and the length of vaginal resection were all significantly less in the study group than in the control group( all P < 0. 05). After 2 years of follow-up,the pregnancy rate was 82. 6% in the study group,which was significantly higher than 65. 2% of the control group. The adverse pregnancy outcome was 10. 5%in the study group,which was significantly lower than 36. 7% of the control group( all P < 0. 05). There was no significant difference in recurrence rate,the mortality rate and satisfaction rate between the groups( P >0. 05). Conclusion For young patients with a tumor diameter < 2 cm,the treatment of vaginal cervical resection plus laparoscopic pelvic lymphadenectomy is better than transabdominal cervical resection + pelvic lymphadenectomy. In practice,appropriate surgical approach for treatment can be selected according to the specific conditions of the patient.