腹腔镜宫颈癌根治术中举宫器的使用对脉管癌栓阳性率的影响

Effects of uterine manipulator on the positive rate of vascular tumor thrombus in laparoscopic radical hysterectomy for cervical cancer

目的探讨腹腔镜宫颈癌根治术中举宫器的应用对脉管癌栓阳性率的影响。方法建立宫颈癌HeLa细胞裸鼠移植瘤模型,分为3组,每组5只,相同压力(1~1.5 kg)处理后收集癌与癌旁组织标本。选取2016年3月—2021年3月于徐州医科大学附属妇幼保健院接受腹腔镜宫颈癌根治术的101例患者及同期宫颈组织病理报告无恶性疾病者68例,分为举宫法组及免举宫法组,免疫组化法检测入组标本中CD34标记微血管密度(MVD)、D2-40标记微淋巴管密度(MLVD)及脉管癌栓阳性率。结果3组裸鼠移植瘤的瘤体和癌旁组织的平均脉管癌栓阳性率差异均无统计学意义(P>0.05),表明在相同压力下,压力作用时间对瘤体和癌旁组织脉管癌栓无影响。宫颈癌和癌旁组织标本中MVD与MLVD高于正常宫颈组织(P<0.05),术中举宫器的使用对癌组织和癌旁组织脉管阳性率无影响(P>0.05)。结论腹腔镜宫颈癌根治术中使用举宫器安全可行。

Objective To evaluate the effects of uterine manipulator on the positive rate of vascular tumor thrombus in laparoscopic radical hysterectomy for cervical cancer.Methods A xenograft model of cervical cancer Hela cells in nude mice was established.The mice were divided into three groups(n=5).After treatment with the same pressure(1~1.5 kg),cancer and adjacent normal tissues were collected.A total of 101 patients who underwent laparoscopic radical cervical cancer surgery in the Maternal and Child Health Care Hospital Affiliated to Xuzhou Medical University from March 2016 to March 2021 and 68 patients without malignant disease by cervical histopathography during the same period were selected.According to the application of uterine manipulator,they were divided into a hysterotomy group and a hysterotomy free group.Then,CD34-labeled microvessel density(MVD),D2-40-labeled microlymphatic vessel density(MLVD)and the positive rate of vascular tumor thrombus were detected by immunohistochemistry.Results There was no difference in the average positive rate of vascular tumor thrombus in tumor and adjacent normal tissues of nude mice in the three groups(P>0.05),which meant that the time of pressure treatment had no effect on the tumor and adjacent normal tissues under the same pressure(P>0.05).The MVD and MLVD of cervical cancer and adjacent normal tissues were higher than those of normal cervical tissue(P<0.05).The use of uterine manipulator exerted no effect on the positive rate of vascular vessels in cervical cancer and adjacent normal tissues(P>0.05).Conclusions It is safe and feasible to use uterine manipulator in laparoscopic radical hysterectomy of cervical cancer.