复发性子宫颈癌行盆腔廓清术围术期情况及近期预后分析

Clinical Analysis of Perioperation and Prognosis of Pelvic Exenteration of Recurrent Cervical Cancer

目的:探讨复发性子宫颈癌盆腔廓清术的安全性、有效性及预后。方法:选择2015年1月1日至2017年11月1日在北京大学人民医院妇科接受盆腔廓清术的6例复发性子宫颈癌患者,通过搜集临床资料和随访进行回顾性分析。结果:年龄40～57岁,平均49.8±6.2岁。3例行全盆腔廓清,3例行前盆腔廓清。术中出血量600～3300 ml,平均2050±1107 ml。平均住院天数17.67±5.65天。随访至2018年3月1日,随访时间6～28月,平均12.83±8.66月。术后出现上尿路积水4例,下肢静脉血栓1例,肠梗阻1例;无并发症者1例。至随访截止日,术后3例无瘤生存,平均无瘤生存13.33月;1例可疑复发;2例病情未控,至随访截止日带瘤生存,平均存活10月。结论:盆腔廓清术手术范围大,并发症发生率高,需注意严格把握手术适应证及预防围术期并发症;满意的盆腔廓清术安全、可行并可以延长患者无瘤生存和总的生存时间。

Objective:To investigate the safety,effectiveness and prognosis of pelvic exenteration of recurrent cervical cancer.Methods:A retrospective analysis was performed including six patients with recurrent cervical cancer who received pelvic exenteration in Peking University People′s Hospital between January 2015 and November 2017.Clinical data and postoperative follow-up was collected.Results:The mean age was 49.8±6.2 years(40-57 years).Three cases were total pelvic exenteration and the other three cases were anterior pelvic exenteration.The mean intraoperative bleeding volume was 2050±1107 ml(600-3300 ml).The average hospitalization time was 17.67±5.65 days.Until March 2018,the average follow-up time was 12.83±8.66 months(6-28 months).During postoperative follow-up,four cases were complicated with upper urinary tract hydrops,one case with venous thrombosis of lower extremity;one case with bowel obstruction and one case with no complication.Up to the deadline of follow-up,three cases were tumor-free survival with the average time of 13.33 months.One case was with suspected recurrence.Two cases were uncontrolled and survived with tumor until the deadline of follow-up(average 10 months).Conclusions:Pelvic exenteration was an operation with large scope and high incidence of postoperative complications.The screening of patients and prevention of perioperative complications were necessary.Satisfactory pelvic exenteration was safe,effective and feasible to increase the tumor-free survival and total survival time according to the results of short-term follow-up.