开腹与腹腔镜手术治疗子宫颈残端癌的临床疗效分析

Clinical Efficacy Analysis of Laparotomy and Laparoscopy for Cervical Stump Carcinoma

目的:探讨子宫颈残端癌临床表现及预后,并分析开腹手术与腹腔镜手术治疗子宫颈残端癌的疗效差异。方法:回顾性分析2009年1月至2019年12月在四川大学华西第二医院接受手术治疗的子宫颈残端癌患者的临床资料、随访生存情况,对比开腹组和腹腔镜组子宫颈残端癌的围手术期结局和生存结局。结果:共纳入64例子宫颈残端癌患者,病理类型包括鳞癌52例(81.3%),非鳞癌12例(18.7%);所有患者均接受残端子宫颈癌广泛切除手术,48例(75.0%)为开腹手术,16例(25.0%)为腹腔镜手术;国际妇产科联盟(FIGO,2018年)分期:Ⅰ期36例(56.3%),Ⅱ期15例(23.4%),Ⅲ期13例(20.3%)。随访期内7例出现复发,6例死亡。开腹组患者的5年无病生存率为89.5%,腹腔镜组为92.3%,差异无统计学意义(P=0.670);开腹组患者的5年总体生存率为93.6%,腹腔镜组为90.9%,差异无统计学意义(P=0.952)。但开腹组术中出血量明显高于腹腔镜组(500 ml vs 100 ml,P<0.001)。结论:子宫颈残端癌治疗预后较好,生存率较高,与开腹手术相比,腹腔镜手术并不增加子宫颈残端癌的复发风险,也未降低生存率,两组肿瘤学结局相似。

Objective:To analyze the clinical manifestations and prognosis of cervical stump carcinoma, and to analyze the efficacy difference between laparotomy and laparoscopy in the treatment.Methods: We retrospectively reviewed clinical data and follow-up survival of patients with cervical stump carcinoma who received surgical treatment in West China Second University Hospital from January 2009 to December 2019.The perioperative and survival outcomes of patients with cervical stump carcinoma were compared between laparotomy group and laparoscopy group.Results: A total of 64 cases of cervical stump carcinoma were included, including 52 cases(81.3%) of squamous carcinoma and 12 cases(18.7%) of non squamous carcinoma.All patients underwent extensive resection of cervical carcinoma at the stump, of which 48 cases(75.0%) were laparotomy and 16 cases(25.0%) were laparoscopic surgery.The FIGO(2018) stage distribution was as follows: 36(56.3%) cases in stage Ⅰ,15(23.4%) cases in stage Ⅱ,13(20.3%) cases in stage Ⅲ.During the follow-up period, 7 patients recurred and 6 cases died.There was no significant difference between laparotomy and laparoscopy group in five-year disease-free survival rate(P=0.670) and five-year overall survival rate(P=0.952).The five-year disease-free survival rate in the laparotomy group was 89.5% versus 92.3% in laparoscopy group, the five-year overall survival rate was 93.6% in laparotomy group versus 90.9% laparoscopy group.But intraoperative bleeding volume was significantly higher in laparotomy group compared with laparoscopy group(500 ml vs.100 ml, P<0.001).Conclusions: The prognosis of cervical stump carcinoma is acceptable and the survival rate is high.Compared with laparotomy, laparoscopic surgery does not increase the recurrence risk of cervical stump carcinoma and does not reduce the survival rate.The oncological outcomes of the two groups are similar.