Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment mo...Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.展开更多
Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas...Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.展开更多
BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterect...BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer.The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery(using traditional laparoscopic or robotic techniques)are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer.Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIM To analyse the perioperative conditions,complications,and short-term and longterm effects in patients undergoing robotic radical hysterectomy(RRH)and laparoscopic radical hysterectomy(LRH)to compare their clinical efficacy,safety,and feasibility.METHODS The perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTS Of the patients,342 underwent LRH for cervical cancer,and 216 underwent RRH.The total complication rate was 9.65%(20 patients)in the RRH group and 17.59%(60 patients)in the LRH group.The complication rate was significantly lower in the RRH group than in the LRH group.There was no significant difference in the follow-up period(P=0.658).The total recurrence rates were 15.7%and 12%in the RRH and LRH groups,respectively.The progression-free survival time was 28.91±15.68 mo and 28.34±15.13 mo in the RRH and LRH groups,respectively(P=0.669).The overall survival(OS)rates were 92.13%and 94.45%in the RRH and LRH groups,respectively(P=0.292).The OS time was 29.87±15.92 mo and 29.41±15.14 mo in the RRH and LRH groups,respectively(P=0.732).The survival curves and the progression-free survival curves were not statistically significantly different between the two groups(P=0.407 and 0.28,respectively).CONCLUSION RRH is associated with significantly less operative time and blood loss than LRH.The two procedures have similar complication rates,OS,and progression-free survival time.展开更多
Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in la...Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in laparoscopic nerve plane-sparing radical hysterectomy(NPSRH),a modified nerve-sparing radical hysterectomy(NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.Methods: From July 2012 to January 2016,257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study.Patients were divided into three cohorts according to the different parametrial resection modality.The clinical,pathological and surgery-related parameters were compared between the three groups.Short-and long-term postoperative bladder functions were evaluated.Results: LEPRD was attempted in 94 patients,and was successful in 65(69.1%) patients(LEPRD group).The remaining 29(30.9%) patients required bipolar coagulation after failure of vascular clipping(combined modality group).Routine bipolar cautery was used in the other 163 patients during the parametrial resection(bipolar group).The blood loss in the LEPRD group was significantly lower than those in the other two groups(P<0.001).The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group(P=0.022).The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group(P=0.019).Conclusions: It is feasible to perform LEPRD in NPSRH for cervical cancers.This kind of limited energy surgical technique is associated with less blood loss,and leads to improved postoperative bladder function.展开更多
To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and...To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraoperative and postoperative complications.The procedure was completed laparoscopically in 108 patients.Two patients were converted to laparotomy due to common iliac vein injury.The mean overall operative time was 200.6±38.6 min;the mean operative blood loss was 280.5±128.3 mL;the mean number of pelvic lymph nodes that were resected was 26.0±5.8.The time for recovery of normal temperature and the normal bladder function after the operation was 5.8±2.9 d and 15.2±4.3 d.There were 2(1.8%) common iliac vein injuries during the operation and 10(9.1%) bladder retentions post operation.It was concluded that TLRH is feasible,minimally invasive and provides promise for the treatment of uterine malignancies.展开更多
Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight p...Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight patients, who received subsequent abdominal hysterectomy or radical hysterectomy after LEEP due to C1N III and cervical cancer （IA1, IA2 and IB1）, were included in the present study. The hospital and clinic records of these patients were reviewed. The patients were divided into three groups according to the time intervals between LEEP and hysterectomy or radical hysterectomy： group l（within 48 h）, group 2 （between 48 h to 6 weeks）, and group 3（〉 6 weeks ）.Results： General characteristics of patients, including the mean age, delivery history, BMI, menopausal status, clinical stage and HPV infection, were comparable between patients of different groups. There were no significant differences in the mean transfusion amount, posthysterectomy hospital stay or operation time between different groups. The frequencies and spectrum of complications were not significantly affected by the time interval between LEEP and hysterectomy or radical hysterectomy. Conclusion： It is concluded that whenever the LEEP is done, the operation including hysterectomy or radical hysterectomy can be conducted at any time as it is necessary for the patients.展开更多
Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complicatio...Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.展开更多
Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in ...Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 5 years in both hospitals, are presented. Laparoscopic systemic pelvic lymphadenectomy with radical vaginal hysterectomy or radical vaginal trachelectomy was performed to patients, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: Between April 2008 and May 2013, 110 patients were submitted to this technique. 15 patients had their surgery aborted: 13 presented positive nodes for carcinoma in contemporary biopsy and 2 had extensive cervical compromise when performing radical vaginal hysterectomy or trachelectomy. Analysis of the remaining 95 cases shows an average age of 43.9 years (26 - 61), all of them had given birth before, 23 (21%) of them through C-section. BMI averaged 30.5 and 31 (28.2%) had cone surgery performed previously. Average duration of surgery was of 220 minutes. Postoperative hospitalization averaged 3.1 days. Bleeding volume was estimated at 125 cc and one patient required blood transfusion. En 25 patients’ uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 25.4 pelvic nodes were obtained. Complications 13.6% with eight patients suffered bladder injury, two had rectovaginal fistula, 3 patients requires surgical repair of ureteral obstruction, two patients present thromboembolic disease. The disease-free and overall survivals are consistent with reports in the literature. Conclusion: We believe that handling patients with this technique is possible and has the advantages of vaginal and laparoscopic surgery with minimal complications.展开更多
目的调查宫颈癌患者术后发生盆底功能障碍性疾病(pelvic fl oor dysfunction,PFD)现状,分析影响因素并提出预防措施。方法选取2023年1—7月在长沙市某三级甲等医院住院的宫颈癌根治术后患者178例为调查对象,使用自行设计的问卷对患者进...目的调查宫颈癌患者术后发生盆底功能障碍性疾病(pelvic fl oor dysfunction,PFD)现状,分析影响因素并提出预防措施。方法选取2023年1—7月在长沙市某三级甲等医院住院的宫颈癌根治术后患者178例为调查对象,使用自行设计的问卷对患者进行横调查,并使用Logistic回归分析宫颈癌根治术后患者盆底功能障碍性疾病的影响因素。结果178例宫颈癌根治术后患者中,105例患者(58.99%)存在盆底功能障碍性疾病,单因素分析结果显示,年龄、妊娠次数、分娩方式、肿瘤直径、绝经、便秘、留置导尿管时间、阴道切除长度均是影响宫颈癌根治术后患者发生盆底功能障碍性疾病的因素(P<0.05),多因素Logistic回归分析结果显示,绝经、便秘、妊娠次数、分娩方式、留置导尿管时间、阴道切除长度为宫颈癌根治术后患者发生盆底功能障碍性疾病的影响因素(P<0.05)。结论宫颈癌根治术后患者女性盆底功能障碍(female pelvic fl oor dysfunction,FPFD)发生率高,绝经、便秘、妊娠次数≥3,阴道分娩、留置导尿管时间≥7 d、阴道切除长度≥3 cm是宫颈癌根治术后患者发生FPFD的危险因素,提示护理人员应给予此类患者更多关注,制定盆底康复训练计划,早期评估FPFD的发生,尽早采取有针对性的措施进行干预。展开更多
文摘Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.
文摘Background： The radical hysterectomy （RH） surgical technique has improved along the years. It is used for the treatment of cervical cancer, endometrial cancer when affecting the cervix, and upper vaginal carcinomas. Our aim was to describe the historical evolution of the technique after the introduction of laparoseopy at our institution. Methods： We performed a retrospective review of medical records of patients who underwent RH, grouped in three periods according to the year of surgery： 1990-1999, 2000-2009 and 2010-2013. Patients＇ characteristics, pathologic details, intraoperative and postoperative complications were analyzed and comoared throughout the time periods. Results： A total of 102 cases of RH were performed at our center during the study period. Among all data collected, the presence of necrosis, age, number of lymph nodes, surgery route, operating time, hospital stay, blood loss and transfusion requirement were statistically significant different among groups. Conversion to laparotomy rate was 19% for the second period compared to the absence of cases in the last one. No significant differences （P=0.124） were observed in the adjuvant treatment received among the three different groups. At the time of the last contact the patients free of disease were 12 （85.7%）, 53 （91.3%） and 26 （86.6%） respectively （P=0.406）. Regarding the disease-free interval, we found significant better outcomes in the group of laparotomy compared to laparoscopy （P=0.015）.Conclusions： Laparoscopic RH is an acceptable surgery with advantages like magnified vision of the operation＇s field, lower surgical complications, shorter hospital stay and earlier resumption to daily activities.
文摘BACKGROUND Cervical cancer is the most common gynecological malignancy,ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year.Traditionally,open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer.The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery(using traditional laparoscopic or robotic techniques)are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer.Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIM To analyse the perioperative conditions,complications,and short-term and longterm effects in patients undergoing robotic radical hysterectomy(RRH)and laparoscopic radical hysterectomy(LRH)to compare their clinical efficacy,safety,and feasibility.METHODS The perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTS Of the patients,342 underwent LRH for cervical cancer,and 216 underwent RRH.The total complication rate was 9.65%(20 patients)in the RRH group and 17.59%(60 patients)in the LRH group.The complication rate was significantly lower in the RRH group than in the LRH group.There was no significant difference in the follow-up period(P=0.658).The total recurrence rates were 15.7%and 12%in the RRH and LRH groups,respectively.The progression-free survival time was 28.91±15.68 mo and 28.34±15.13 mo in the RRH and LRH groups,respectively(P=0.669).The overall survival(OS)rates were 92.13%and 94.45%in the RRH and LRH groups,respectively(P=0.292).The OS time was 29.87±15.92 mo and 29.41±15.14 mo in the RRH and LRH groups,respectively(P=0.732).The survival curves and the progression-free survival curves were not statistically significantly different between the two groups(P=0.407 and 0.28,respectively).CONCLUSION RRH is associated with significantly less operative time and blood loss than LRH.The two procedures have similar complication rates,OS,and progression-free survival time.
基金supported by the special fund for Capital City Clinical Specific Application Study(No.Z171100001017115)
文摘Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in laparoscopic nerve plane-sparing radical hysterectomy(NPSRH),a modified nerve-sparing radical hysterectomy(NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.Methods: From July 2012 to January 2016,257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study.Patients were divided into three cohorts according to the different parametrial resection modality.The clinical,pathological and surgery-related parameters were compared between the three groups.Short-and long-term postoperative bladder functions were evaluated.Results: LEPRD was attempted in 94 patients,and was successful in 65(69.1%) patients(LEPRD group).The remaining 29(30.9%) patients required bipolar coagulation after failure of vascular clipping(combined modality group).Routine bipolar cautery was used in the other 163 patients during the parametrial resection(bipolar group).The blood loss in the LEPRD group was significantly lower than those in the other two groups(P<0.001).The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group(P=0.022).The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group(P=0.019).Conclusions: It is feasible to perform LEPRD in NPSRH for cervical cancers.This kind of limited energy surgical technique is associated with less blood loss,and leads to improved postoperative bladder function.
文摘To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraoperative and postoperative complications.The procedure was completed laparoscopically in 108 patients.Two patients were converted to laparotomy due to common iliac vein injury.The mean overall operative time was 200.6±38.6 min;the mean operative blood loss was 280.5±128.3 mL;the mean number of pelvic lymph nodes that were resected was 26.0±5.8.The time for recovery of normal temperature and the normal bladder function after the operation was 5.8±2.9 d and 15.2±4.3 d.There were 2(1.8%) common iliac vein injuries during the operation and 10(9.1%) bladder retentions post operation.It was concluded that TLRH is feasible,minimally invasive and provides promise for the treatment of uterine malignancies.
文摘Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight patients, who received subsequent abdominal hysterectomy or radical hysterectomy after LEEP due to C1N III and cervical cancer （IA1, IA2 and IB1）, were included in the present study. The hospital and clinic records of these patients were reviewed. The patients were divided into three groups according to the time intervals between LEEP and hysterectomy or radical hysterectomy： group l（within 48 h）, group 2 （between 48 h to 6 weeks）, and group 3（〉 6 weeks ）.Results： General characteristics of patients, including the mean age, delivery history, BMI, menopausal status, clinical stage and HPV infection, were comparable between patients of different groups. There were no significant differences in the mean transfusion amount, posthysterectomy hospital stay or operation time between different groups. The frequencies and spectrum of complications were not significantly affected by the time interval between LEEP and hysterectomy or radical hysterectomy. Conclusion： It is concluded that whenever the LEEP is done, the operation including hysterectomy or radical hysterectomy can be conducted at any time as it is necessary for the patients.
文摘Radical hysterectomy(RH) and pelvic lymphadenectomy are the main treatment methods for early cervical cancer and endometrial carcinoma.Effective care measures,however,can decrease the incidence of UTIs and complications associated with RH and pelvic lymphadenectomy,as well as improve the therapeutic effects of administered drugs and patient prognosis.The writer refers to relevant literatures to analyze the reasons for postoperative UTIs and to provide a brief summary of the nursing methods for and progress in UTI prevention.
文摘Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 5 years in both hospitals, are presented. Laparoscopic systemic pelvic lymphadenectomy with radical vaginal hysterectomy or radical vaginal trachelectomy was performed to patients, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: Between April 2008 and May 2013, 110 patients were submitted to this technique. 15 patients had their surgery aborted: 13 presented positive nodes for carcinoma in contemporary biopsy and 2 had extensive cervical compromise when performing radical vaginal hysterectomy or trachelectomy. Analysis of the remaining 95 cases shows an average age of 43.9 years (26 - 61), all of them had given birth before, 23 (21%) of them through C-section. BMI averaged 30.5 and 31 (28.2%) had cone surgery performed previously. Average duration of surgery was of 220 minutes. Postoperative hospitalization averaged 3.1 days. Bleeding volume was estimated at 125 cc and one patient required blood transfusion. En 25 patients’ uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 25.4 pelvic nodes were obtained. Complications 13.6% with eight patients suffered bladder injury, two had rectovaginal fistula, 3 patients requires surgical repair of ureteral obstruction, two patients present thromboembolic disease. The disease-free and overall survivals are consistent with reports in the literature. Conclusion: We believe that handling patients with this technique is possible and has the advantages of vaginal and laparoscopic surgery with minimal complications.
文摘目的建立一个基于矢状位T2加权图像(T2 weighted imaging,T2WI)的瘤内结合不同瘤周区域影像组学特征和临床危险因素的列线图,评估其术前预测宫颈癌ⅠB期和ⅡA期的价值。材料与方法回顾性分析120例两家医院术前接受MRI检查和根治性子宫切除术加盆腔淋巴清扫并经术后病理证实的ⅠB和ⅡA期宫颈癌患者的实验室检查资料和MRI图像,分为训练组和外部验证组,对矢状位T2WI图像瘤内感兴趣区(region of interest,ROI)和1~6 mm的瘤周环(ROI-1、ROI-2、ROI-3、ROI-4、ROI-5和ROI-6)分别提取影像组学特征,采用Pearson分析和最小绝对收缩和选择算子(the least absolute shrinkage and selection operator,LASSO)回归进行特征选择。以最佳者绘制受试者工作特征(receiver operating characteristic,ROC)曲线,构建0~6 mm瘤周影像组学模型,并筛选出最佳影像组学模型,基于以上最佳影像组学模型评分与临床独立危险因素构建联合模型,并绘制列线图,以校准曲线评估模型校准度,以决策曲线分析(decision curve analysis,DCA)评价模型的应用价值。结果由瘤内结合瘤周3 mm区域得到6个有效特征建立的影像组学模型预测效能最佳,在训练组和外部验证组,其曲线下面积(area under the curve,AUC)分别为0.972和0.857。由肿瘤最大径、红细胞计数(red blood cell,RBC)的临床独立危险因素建立的临床模型预测效能次之,在训练组和外部验证组AUC分别为0.940和0.847。基于肿瘤最大径、RBC、瘤内结合瘤周3 mm的6个有效特征构建的列线图预测效能更稳定,在训练组和外部验证组AUC分别为0.952和0.939,经校准曲线和DCA分析,列线图的校准度较高,临床净收益较大。结论基于T2WI瘤内和瘤周3 mm组学特征构建的影像组学列线图可以较好地术前预测ⅠB期和ⅡA期宫颈癌,对指导患者个体化治疗有着重要临床意义。
文摘目的调查宫颈癌患者术后发生盆底功能障碍性疾病(pelvic fl oor dysfunction,PFD)现状,分析影响因素并提出预防措施。方法选取2023年1—7月在长沙市某三级甲等医院住院的宫颈癌根治术后患者178例为调查对象,使用自行设计的问卷对患者进行横调查,并使用Logistic回归分析宫颈癌根治术后患者盆底功能障碍性疾病的影响因素。结果178例宫颈癌根治术后患者中,105例患者(58.99%)存在盆底功能障碍性疾病,单因素分析结果显示,年龄、妊娠次数、分娩方式、肿瘤直径、绝经、便秘、留置导尿管时间、阴道切除长度均是影响宫颈癌根治术后患者发生盆底功能障碍性疾病的因素(P<0.05),多因素Logistic回归分析结果显示,绝经、便秘、妊娠次数、分娩方式、留置导尿管时间、阴道切除长度为宫颈癌根治术后患者发生盆底功能障碍性疾病的影响因素(P<0.05)。结论宫颈癌根治术后患者女性盆底功能障碍(female pelvic fl oor dysfunction,FPFD)发生率高,绝经、便秘、妊娠次数≥3,阴道分娩、留置导尿管时间≥7 d、阴道切除长度≥3 cm是宫颈癌根治术后患者发生FPFD的危险因素,提示护理人员应给予此类患者更多关注,制定盆底康复训练计划,早期评估FPFD的发生,尽早采取有针对性的措施进行干预。
