改良腹腔镜根治性子宫颈切除术在早期子宫颈癌保留生育功能中的应用

Application of modified laparoscopic radical trachelectomy in cervical cancer for fertility preservation

目的探讨改良腹腔镜根治性子宫颈切除术在早期子宫颈癌保留生育功能中的安全性和可行性。方法回顾性分析2017年6月至2020年10月在中山大学孙逸仙纪念医院妇科肿瘤科接受传统腹腔镜(13例)和改良腹腔镜(12例)根治性子宫颈切除术+盆腔淋巴结切除术的早期子宫颈癌患者的临床资料,比较两组临床病理特征、手术情况、术后并发症、妊娠情况及肿瘤结局。结果改良腹腔镜组和传统腹腔镜组的临床病理资料、手术情况及术后并发症发生率的差异无统计学意义(P>0.05)。传统腹腔镜组随访时间长于改良腹腔镜组(37.0个月vs.14.5个月,P<0.05)。改良腹腔镜组中有妊娠计划者4例,成功妊娠者3例(3/4),而传统腹腔镜组中有妊娠计划者4例,成功妊娠者仅1例(1/4),差异不具有统计学意义(P>0.05)。两组在中位随访时间29个月内,均未见复发和死亡病例,无病生存率(DFS)和总生存率(OS)均为100%。结论改良腹腔镜根治性子宫颈切除术在保留生育功能的早期子宫颈癌患者中的应用安全可行,是否能进一步改善肿瘤结局和妊娠率,还需大样本随机对照试验进一步证实。

Objective To evaluate the safety and feasibility of modified laparoscopic radical trachelectomy to preserve fertility in early-stage cervical cancer.Methods The clinical data,including pathological data,perioperative results,complications,pregnancy and oncological outcomes,were retrospectively analyzed and compared in 25 patients with early-stage cervical cancer,who underwent traditional laparoscopic radical trachelectomy(TLRT,n=13)and modified laparoscopic radical trachelectomy(MLRT,n=12)plus pelvic lymphadenectomy in the Department of Gynecological Oncology,Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2017 to October 2020.Results There was no significant difference in clinical pathological characteristics,perioperative results or incidence of complications between MLRT group and TLRT group(P>0.05). The follow-up time in the TRTL group was longer than that in the MLRT group(37.0 months vs. 14.5 months,P<0.05). In the MLRT group,there were 4 cases of pregnancy plan and 3 cases of successful pregnancy(75%),while in TLRT group,there were 4 cases of pregnancy plan and only 1 case of successful pregnancy(25%),and the difference was not statistically significant(P>0.05). During the median follow-up period of 29 months,there was no recurrence or death in both groups,and the disease-free survival rate(DFS)and overall survival rate(OS)were both 100%.Conclusion The application of MLRT in early-stage cervical cancer is safe and feasible,and whether it can further improve the tumor outcome and pregnancy rate needs to be further confirmed by large randomized controlled trials.