Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer

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.

Radical Hysterectomy in Cervical Cancer: Patients’ Epidemiological and Clinical Profiles and Perioperative Outcome in Two Referral Hospitals in Cameroon

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.

Evolution of radical hysterectomy for cervical cancer along the last two decades: single institution experience

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.

Radical Vaginal Hysterectomy and Trachelectomy in Early-Stage Cervical Cancer

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.

Neoadjuvant chemotherapy for locally advanced cervical cancer reduces surgical risks and lymph-vascular space involvement

Neoadjuvant chemotherapy(NACT),which can reduce the size and therefore increase the resectability of tumors,has recently evolved as a treatment for locally advanced cervical cancer.NACT has been reported to decrease the risk of pathologic factors related to prognosis of cervical cancer.To further assess the effects of NACT on surgery and the pathologic characteristics of cervical cancer,we reviewed 110 cases of locally advanced cervical cancer treated with radical hysterectomy with or without NACT at the People's Hospital of Peking University between January 2006 and December 2010.Of 110 patients,68 underwent platinum-based NACT prior to surgery(NACT group) and 42 underwent primary surgery treatment(PST group).Our results showed 48 of 68(70.6%) patients achieved a complete response or partial response to NACT.Estimated blood loss,operation time,and number of removed lymph nodes during surgery,as well as complication rates during and after surgery were not significantly different between the NACT group and the PST group.The rates of deep stromal invasion,positive parametria,positive surgical vaginal margins,and lymph node metastasis were not significantly different between the two groups.However,the rate of lymph-vascular space involvement(LVSI) was significantly lower in the NACT group than in the PST group(P = 0.021).In addition,the response rate of NACT was significantly higher in the patients with chemotherapeutic drugs administrated via artery than via vein.Our results suggest that NACT is a safe and effective treatment for locally advanced cervical cancer and significantly decreases the rate of LVSI.

Different strategies of treatment for uterine cervical carcinoma stage ⅠB2-ⅡB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.

Influences of different time intervals between loop electrosurgical excision and abdominal hysterectomy or radical hysterectomy on postoperative complications: a retrospective analysis

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.

经阴道单孔腹腔镜在保留盆腔自主神经的广泛子宫切除术中的应用探讨1例(附手术视频)

宫颈癌是常见的女性生殖系统恶性肿瘤,其早期手术治疗的标准术式是子宫广泛性切除及盆腔淋巴结清扫,手术路径主要包括开放手术、微创手术和经阴道手术等[1]。随着微创技术的快速发展,微创手术被广泛应用于早期宫颈癌的治疗。

腹腔镜下保留盆腔自主神经广泛性子宫切除术在Ⅰa、Ⅰb1期宫颈癌患者中的应用

目的探究Ⅰa、Ⅰb1期宫颈癌患者行腹腔镜下保留盆腔自主神经广泛性子宫切除术(LNSRH)对其尿流动力学、性功能及并发症发生情况的影响。方法选取2019年5月至2022年5月在徐州市妇幼保健院接受治疗的早期宫颈癌患者80例为研究对象,采用随机数字表法分成对照组(n=40)和观察组(n=40)。对照组行腹腔镜下广泛性子宫切除术(LRH),观察组行LNSRH。比较两组患者的基本资料、围术期指标、肿瘤标志物水平、尿流动力学指标、性功能评分及并发症发生情况。结果两组患者的临床分期、年龄、体质量指数、病理类型比较均无显著性差异(P>0.05)。观察组手术时间显著长于对照组[(246.85±30.79)min vs.(227.41±28.43)min,P<0.05];两组出血量、清扫淋巴结数量、切除阴道长度、住院时间比较均无显著性差异(P>0.05)。两组患者术后的糖类抗原125(CA-125)、鳞状上皮细胞癌抗原(SCCA)水平均显著低于术前(P<0.05);两组间术后CA-125、SCCA水平比较无显著性差异(P>0.05)。两组患者术后最大尿流率(MFR)、最大逼尿肌收缩压(MDP)、膀胱顺应性水平均显著低于术前(P<0.05);观察组术后MFR、MDP及膀胱顺应性水平显著高于对照组(P<0.05)。两组患者术后女性性功能量表(FSFI)各维度评分均显著低于术前(P<0.05);观察组术后FSFI各维度评分显著高于对照组(P<0.05)。观察组术后并发症发生率显著低于对照组(12.50%vs.32.50%,P<0.05)。结论对Ⅰa、Ⅰb1期宫颈癌患者予以LNSRH和LRH治疗均有较好的疗效,可有效降低肿瘤标志物水平,且LNSRH对患者尿流动力学和性功能影响较小,术后并发症较少。

舒适护理在腹腔镜宫颈癌根治术护理中的应用

目的舒适护理在腹腔镜宫颈癌根治术护理中的应用分析。方法选取入我院进行腹腔镜宫颈癌根治术医治患者100例为研究对象,选取时段2021年7月至2023年1月,依照护理方式不同将患者分为观察组(n=50)与对照组(n=50),对照组实施常规护理,观察组采取舒适护理,对两组患者术后疼痛评分、引流时长、首次排气用时、下床活动用时、并发症发生率、护理满意度以及生活质量总评分进行比对。结果经比对,观察组患者疼痛评分、引流时长、首次排气用时、下床活动用时、并发症发生率均较对照组低,护理满意度和生活质量总评分均高于对照组(均P<0.05)。结论通过在腹腔镜宫颈癌根治术护理中应用舒适护理干预,可降低术后痛感和出现并发症概率,具有较高安全性,优化生活质量,提高患者护理满意度。

Nerve plane-sparing radical hysterectomy： a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer

Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy. Methods From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients （nerve-sparing radical hysterectomy group）. The detailed autenomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients （nerve plane-sparing radical hysterectomy group）. During this modified procedure, the nerve plane （meso-ureter and its extens;ion） containing most of the autonomic nerve structures was integrally preserved. The patients＇ clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups. Results There were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group （P=0.028）. The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were （262_＋46） minutes and （341＋36） minutes （P 〈0.01）. On the 8th postoperative day, 41 （71.9%） patients in the nerve plane-sparing radical hysterectomy group and nine （56.3%） patients in the nerve-sparing radical hysterectomy group had a postvoid residual urine volume of 〈100 ml （P=0.233）. The median duration of catheterization was eight days （range 8-23 days） for the nerve plane-sparing radical hysterectomy group and eight days （range 8-22 days） for the nerve-sparing radical hysterectomy group （P=-0.509）. Neither surgery-related injury nor pathologically positive margins were reported in either group. Conclusion Nerve plane-sparing radical hysterectomy is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.

精准膜解剖下保留盆腔自主神经宫颈癌根治术疗效观察

目的观察精准膜解剖下保留盆腔自主神经宫颈癌根治术的疗效。方法选取2020年12月至2022年12月我院收治的60例宫颈癌患者,按照随机数字表法分为对照组和观察组,每组30例。对照组患者采用传统根治性子宫切除术治疗,观察组患者采用精准膜解剖下保留盆腔自主神经宫颈癌根治术治疗。比较2组患者手术指标、术后恢复情况、并发症发生情况及术后6个月生存情况。术前及术后6个月检测2组患者的残余尿量(RUV)、最大尿流率(MFR)、平均尿流率(AFR)、最大尿意膀胱容量(BVMS)、初始尿意膀胱容量(BVFS)及最大逼尿肌压力等尿动力学指标。结果与对照组相比,观察组患者手术时间更长,宫旁和阴道切除长度更短,术中出血量、术后切缘阳性率更少/低,淋巴结清扫数更多,差异均有统计学意义(P<0.05)。与对照组相比,观察组患者术后留置尿管时间、术后肛门排气和排便时间更短,术后膀胱功能障碍发生率更低,差异均有统计学意义(P<0.05)。2组患者术后6个月RUV、BVMS、BVFS明显增加(P<0.05),但观察组患者术后6个月RUV、BVMS、BVFS低于对照组(P<0.05);2组患者术后6个月MFR、AFR、最大逼尿肌压力均明显降低(P<0.05),但观察组术后6个月MFR、AFR、最大逼尿肌压力高于对照组(P<0.05)。观察组患者并发症总发生率(6.67%)低于对照组(36.67%),差异有统计学意义(P<0.05)。术后随访6个月,2组生存率、复发率和转移率比较,差异无统计学意义(P>0.05)。结论精准膜解剖下保留盆腔自主神经宫颈癌根治术治疗宫颈癌,能够显著改善手术指标、尿动力学指标,促进术后恢复,降低并发症发生率。

Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer

Background:After radical hysterectomy for cervical cancer,the most common complication is lower urinary tract symptoms.Post-operatively,bladder capacity can alter bladder function for a prolonged period.This study aimed to identify factors affecting bladder storage function.Methods:A multicenter,retrospective cohort study was conducted.Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria.Demographic,surgical,and oncological data were collected.The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively.Ninety-five(46.8%)patients were diagnosed with stress urinary incontinence(SUI).The incidence of low bladder compliance(LBC)was 23.2%.Twenty-seven(13.3%)patients showed detrusor overactivity(DO).Fifty-seven patients(28.1%)presented with a decreased maximum cystometric capacity(DMCC).The probability of composite bladder storage dysfunction was 68.0%.Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498(P=0.034).Patients who underwent a nerve-sparing procedure were less odds to experience SUI(P=0.014).A significant positive correlation between LBC and DO was observed(P<0.001).A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO,while radiotherapy exerted a stronger effect than chemotherapy.Additionally,patients who received chemoradiotherapy frequently developed a DMCC.The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.

基于矢状位T2WI瘤内瘤周影像组学列线图术前预测ⅠB期和ⅡA期宫颈癌的研究

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。

根治性子宫切除术结合盆腔淋巴结清扫术对宫颈癌患者血清CA-199、CA125、SCC-Ag水平的影响

目的 探讨根治性子宫切除术结合盆腔淋巴结清扫术应用于宫颈癌患者的效果及对患者血清肿瘤标志物糖类抗原199(CA199)、糖类抗原125(CA125)、鳞状上皮细胞癌抗原(SCC-Ag)水平的影响。方法 选取2018年1月至2023年6月期间于芜湖市第二人民医院接受手术治疗的118例宫颈癌患者资料,根据手术方式不同分为传统开腹组(42例,接受传统开腹根治性子宫切除术)和微创组(76例,接受腹腔镜下根治性子宫切除术联合盆腔淋巴结清扫术),比较两组手术效果及患者血清肿瘤标志物水平差异。结果 微创组手术时间较开腹组更长,术中出血量较开腹组少,住院时间、胃肠道恢复时间短于开腹组,差异均有统计学意义(t=6.881、12.348、21.622、11.780,P<0.05);与术前比较,术后两组血清CA-199、CA125、SCC-Ag水平均下降:术前>术后2周>术后1月,微创组术后各时间点上述指标水平均低于开腹组,差异有统计学意义(F=237.516、8.733、6.182、251.616、12.520、7.069、250.512、14.554、4.663,P<0.05);微创组术后并发症总发生率低于开腹组,差异有统计学意义(χ^(2)=4.116,P<0.05)。结论 腹腔镜下根治性子宫切除术结合盆腔淋巴结清扫术治疗宫颈癌,可以优化手术效果,促进术后康复,提高安全性,改善预后。

“垂钓式”子宫悬吊联合阴道荷包缝合包埋宫颈的腹腔镜广泛性子宫切除术

目的探讨“垂钓式”子宫悬吊联合阴道荷包缝合包埋宫颈的改良腹腔镜广泛性子宫切除术的安全性及有效性。方法回顾性分析2021年10月~2023年8月82例Querleu-Morrow分型C2型广泛性子宫切除术资料,其中36例腹腔镜手术(腹腔镜组),46例开放手术(开放组)。腹腔镜组采用“垂钓式”子宫悬吊避免使用举宫杯,阴道荷包缝合包埋宫颈后切开阴道壁。比较2组手术时间、术中出血量、并发症、病理切缘阳性率及复发率。结果腹腔镜组术中出血量、术后住院时间明显少于开放组[40(30~130)ml vs.80(20~300)ml,Z=-4.057,P=0.000;8.5(5~24)d vs.10(5~26)d,Z=-2.975,P=0.003];2组手术时间、并发症发生率、淋巴结切除个数、切缘阳性率、复发率差异均无统计学意义(P>0.05)。结论“垂钓式”子宫悬吊联合阴道荷包缝合包埋宫颈的改良腹腔镜广泛性子宫切除术治疗早期宫颈癌安全有效。

宫颈癌根治术后膀胱功能障碍预防与膀胱功能康复管理的研究进展

宫颈癌是女性生殖系统最常见的恶性肿瘤,根治性子宫切除术结合盆腔淋巴结清扫术是其主要的治疗方式。然而,由于手术创伤及术中神经损伤,术后患者易发生膀胱功能障碍,严重影响患者预后和生活质量。本文综述了国内外有关宫颈癌根治术后患者膀胱功能障碍的预防与膀胱功能康复管理的研究文献,主要内容包括改进手术方式、早期拔除导尿管、预防尿路感染、心理干预及应用膀胱功能康复技术等,旨在为临床医护人员进行患者膀胱功能康复管理提供参考,以促进患者膀胱功能的恢复,进而改善患者预后和生活质量。

腹腔镜下子宫深静脉入路C型宫颈癌根治术的疗效

目的探讨腹腔镜下子宫深静脉入路C型宫颈癌根治术治疗宫颈癌的疗效。方法2021年1月~2022年12月我院采用腹腔镜下子宫深静脉入路C型宫颈癌根治术+盆腔淋巴结清扫术±腹主动脉旁淋巴结切除术治疗58例宫颈癌。建立通道后,在阔韧带后叶定位输尿管,分离输尿管后暴露子宫动脉,沿子宫动静脉背侧分离结缔组织,逐渐暴露子宫深静脉。将包绕子宫深静脉周围的宫旁淋巴结切除,单独送病理检查。继续向膀胱方向追踪子宫深静脉,游离其属支,血管夹双重夹闭。结果手术时间(307.2±54.1)min,出血量中位数50(20,100)ml,淋巴结清扫(26.3±6.9)枚,留置导尿管时间(20.6±4.7)d,拔除腹腔引流管时间(9.4±4.1)d,肛门排气时间(36.7±4.1)h,抗生素使用时间(9.2±4.2)d,住院时间(13.4±2.6)d。术后并发症发生率3.4%(2/58)。术后病理分期升级率为22.4%(13/58)。术后欧洲癌症研究治疗组织(European Organization of Research and Treatment of Cancer,EORTC)生活质量核心30问卷(Quality of Life Questionnaire-Core 30,QLQ-C30)评分较术前显著升高[(78.6±10.7)分vs.(47.1±7.6)分,t=17.177,P=0.000]。58例随访4~25个月,(13.5±6.2)月,无复发。结论腹腔镜下子宫深静脉入路C型宫颈癌根治术疗效确切、安全可靠。

MRI瘤周影像组学术前预测ⅠB~ⅡB期宫颈癌宫旁浸润

目的建立一个基于矢状位T2加权图像(T2WI)中瘤内结合不同瘤周组学特征和临床危险因素联合模型来预测ⅠB~ⅡB期宫颈癌宫旁浸润。方法回顾性分析2018年1月~2024年4月在陕西中医药大学第二附属医院西咸院区术前接受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~ⅡB期宫颈癌患者180例,对其矢状位T2WI图像瘤内感兴趣区(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LASSO回归进行特征选择,构建不同瘤周组学模型并筛选出最佳组学模型,基于最佳组学特征与临床独立危险因素构建联合模型,利用ROC、校准曲线和决策曲线分析(DCA)评估模型的预测性能、校准度和应用价值。结果由瘤内结合瘤周3 mm区域得到的4个有效特征建立的组学模型预测效能最佳,在训练组和内部验证组,AUC分别为0.980和0.770;肿瘤最大径、血小板计数为临床独立危险因素,由肿瘤最大径、血小板计数建立的临床模型预测效能次之,AUC分别为0.860和0.673;基于瘤内结合瘤周3 mm的4个有效特征、肿瘤最大径和血小板计数构建的联合模型预测效能更稳定,AUC分别为0.952和0.939,经校准曲线和决策曲线分析,瘤内结合瘤周3 mm建立的组学模型校准度较高,临床净收益较大。结论基于MRI瘤内瘤周影像组学特征和临床参数的联合模型可以更好地术前预测ⅠB~ⅡB期宫颈癌宫旁浸润,对指导患者个体化治疗有着重要临床意义。

膜解剖理念相较于传统解剖理念在机器人辅助腹腔镜下宫颈癌根治术中的优势探讨(附手术视频)

目的:探讨机器人辅助腹腔镜手术治疗宫颈癌中运用膜解剖理念的优势。方法:回顾性分析2020年3月—2023年3月在厦门大学附属第一医院行机器人辅助手术的36例宫颈癌患者的临床资料,其中14例运用膜解剖理念进行手术的患者分为膜解剖组,22例传统解剖理念下进行手术的患者分为传统解剖组。比较两组患者的基本资料及手术时间、平均术中出血量、平均拔除尿管后残余尿量、平均术后住院时间等手术相关指标。结果:36例患者均顺利完成手术,无中转开腹病例。两组患者手术相关指标相比,膜解剖组患者手术时间更短,平均术中失血量更少,平均拔除尿管后残余尿量更少,平均术后住院时间更短,差异具有统计学意义(P<0.05)。膜解剖组患者暴露盆丛比例高于传统解剖组(92.86%Vs 36.36%),两组患者暴露深静脉并离断比例均为100%。结论:运用膜解剖理念在机器人辅助腹腔镜下宫颈癌根治术中优势明显。