ⅠA2~ⅡA2期子宫颈癌腹腔镜手术与假性脉管浸润关系探讨

Study on the relationship between laparoscopic surgery and the incidence of pseudovascular invasion inⅠA2-ⅡA2 cervical cancer

目的探讨腹腔镜手术治疗的ⅠA2~ⅡA2期子宫颈癌中假性脉管浸润(PVI)发生情况及对预后的影响。方法回顾性分析2012年1月至2013年12月于大连市妇女儿童医疗中心(集团)行手术治疗且临床病理资料完整的国际妇产科联盟(FIGO)2009ⅠA2~ⅡA2期子宫颈癌患者共183例。分为腹腔镜组80例(43.7%),开腹组103例(56.3%)。由1名有经验的病理医生对所有病理切片重新阅读,比较两组PVI的发生率,并分析PVI发生的相关因素、患者术后辅助治疗及生存情况。结果183例子宫颈癌患者中,PVI共33例(18.0%),腹腔镜组中PVI的发生率(26.3%,21/80)明显高于开腹组(11.7%,12/103)(P=0.011)。单因素分析显示,PVI与淋巴脉管间隙浸润(LVSI)(P=0.00)、手术方式(P=0.011)有关;多因素分析显示,LVSI(P=0.000)及腹腔镜手术(P=0.005)增加PVI发生风险。PVI阳性患者的5年无病生存率(90.9%)和总生存率(93.9%)均高于PVI阴性患者(84.0%、87.3%),但两者间差异无统计学意义(P>0.05)。6例PVI错误判读为LVSI,其中有2例患者术后接受了不必要的辅助治疗。结论对于ⅠA2~ⅡA2期子宫颈癌,腹腔镜手术的PVI发生率高于开腹手术;PVI误诊为LVSI可能会增加术后不必要的辅助治疗,但目前尚不能证明PVI对预后有影响。

Objective To analyze the the incidence and significance of pseudovascular invasion(PVI)inⅠA2-ⅡA2 cervical cancer treated by laparoscopic surgery.Methods A total of 183 patients with cervical cance(r 2009 FIGO stageⅠA2-ⅡA2)who received surgical treatment from January 2012 to December 2013 in Dalian Women and Children's Medical Group were retrospectively analysed,including 80 cases(43.7%)who underwent laparoscopic surgery and 103 cases(56.3%)underwent laparotomy.All pathological sections were reviewed by an experienced pathologist to compare the incidence of PVI and analyze the factors related to PVI incidence,assisted treatment after treatment and patients'survival.Results Among the 183 patients with cervical cancer,there were 33 cases(18.0%)of PVI,and the incidence of PVI in laparoscopic group(26.3%,21/80)was significantly higher than that in laparotomy group(11.7%,12/103)(P=0.011).Univariate analysis showed that PVI was related to lymphovascular space invasion(LVSI)(P=0.00)and modes of surgery(P=0.011);multivariate analysis showed that LVSI(P=0.000)and laparoscopic surgery(P=0.005)increased the risk of PVI.The 5-year DFS(90.9%)and OS(93.9%)of PVI positive patients were higher than those of PVI negative patients(84.0%,87.3%),but there was no significant difference between them(P>0.05).Six cases of PVI were incorrectly interpreted as LVSI,and 2 of them received unnecessary adjuvant therapy after surgery.Conclusion The incidence of PVI in laparoscopic surgery is higher than that in open surgery forⅠA2-ⅡA2 cervical cancer.The misdiagnosis of PVI as LVSI may increase unnecessary adjuvant therapy,but PVI has not been proved to have an effect on prognosis.