宫颈冷刀锥切术对ⅠA1期宫颈癌患者生育功能的保留作用

Cervical cold knife cut method for patients with stage ⅠA1 cervical cone preservation of reproductive function research

目的探讨宫颈冷刀锥切术对于ⅠA1期宫颈癌患者生育功能的保留作用。方法采用随机数字表法将106例接受手术治疗的ⅠA1期宫颈癌患者分为宫颈冷刀锥切术(CKC)组和经阴道广泛性宫颈切除术(RVT)组。比较两组患者的手术指标(手术用时、术中出血量、创面愈合时间)及术后3个月的血清学指标[癌胚抗原(CEA)、甲胎蛋白(AFP)、C反应蛋白(CRP)水平]。统计两组患者的3年复发率、3年生存率和妊娠结局。结果CKC组患者的手术时间、创面愈合时间均明显短于RVT组患者,术中出血量明显少于RVT组患者(P<0.01)。术后3个月,两组患者的CEA、AFP、CRP水平均较本组术前降低,且CKC组患者的CRP水平低于RVT组患者(P<0.05)。CKC组患者的3年复发率为3.77%(2/53),低于RVT组患者的16.98%(9/53)(P<0.05);两组患者的3年生存率比较,差异无统计学意义(P>0.05)。结论宫颈冷刀锥切术可提高ⅠA1期宫颈癌患者的术后妊娠率,改善妊娠结局,并具有术后恢复快、术中出血少等优势。

Objective To investigate the effect of the cervical cold knife cut method for patients with stage ⅠA1 cervical cone preservation of reproductive function research.Method 106 patients with stage ⅠA1 cervical cancer were randomly divided into cervical cold knife conization(CKC)group and radical vaginal trachelectomy(RVT)group.The operation indexes(operation time,intraoperative blood loss,wound healing time)and serological indexes[carcinoembryonic antigen(CEA),alpha fetoprotein(AFP),C-reactive protein(CRP)]3 months after operation were compared between the two groups.The 3-year recurrence rate,3-year survival rate and pregnancy outcome of the two groups were statistically analyzed.Result The operation time and wound healing time of CKC group were significantly shorter than those of RVT group,and the intraoperative blood loss was significantly less than that of RVT group(P<0.01).Three months after operation,the levels of CEA,AFP and CRP in the two groups were lower than those before operation,and CRP level in CKC group was lower than that in RVT group(P<0.05).After 3-year follow-up,the recurrence rate of CKC group was3.77%(2/53),the recurrence rate of RVT group was 16.98%(9/53),and CKC group was lower than RVT group(P<0.05).There was no significant difference in the 3-year survival rate between the two groups.Conclusion Cervical cold knife cut method can improve the ⅠA1 stage of cervical cancer patients with postoperative pregnancy rate,improve pregnancy outcome,and have a fast recovery,less intraoperative bleeding.