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
Radical trachelectomy (RT) is a fertility-sparing treatment for young women with early-stage cervical cancer. We report here a case of a 30-year-old nulliparous woman who presented with stage IA2 cervical squamous c...Radical trachelectomy (RT) is a fertility-sparing treatment for young women with early-stage cervical cancer. We report here a case of a 30-year-old nulliparous woman who presented with stage IA2 cervical squamous cancer. She was treated with total laparoscopic radical trachelectomy (TLRT) and laparoscopic pelvic lymphadenectomy (LPL). During this procedure, the ascending branches of uterine arteries were preserved. No metastasis was identified after fourteen months of follow-up. The menstrual pattern normalized and the patient has been attempting to conceive for two months.TLRT might be a safe fertility-preserving procedure for early-stage cervical cancer, due to its minimally invasive nature and shorter recovery time. However, more data are required on recurrence rate, fertility rate and pregnancy outcome in order to fully evaluate the therapeutic efficacy of TLRT.展开更多
目的分析早期宫颈癌患者行根治性宫颈切除术(RT)和根治性全子宫切除术(RH)后5年无瘤生存率及5年总生存率(即以病人从确诊后再经治疗生存5年的病人数占同期病人总数的百万分比衡量疗效),术中和术后并发症、输血率及RT后的妊娠结...目的分析早期宫颈癌患者行根治性宫颈切除术(RT)和根治性全子宫切除术(RH)后5年无瘤生存率及5年总生存率(即以病人从确诊后再经治疗生存5年的病人数占同期病人总数的百万分比衡量疗效),术中和术后并发症、输血率及RT后的妊娠结局。方法应用电子计算机检索PubMed数据库,Cochrane图书馆(2014)、ISI Web of Knowledge、OVID、web.science、Ebsco-medline、超星Medalink、万方、CNKI等数据库并辅以手工检索相关期刊,截止2014年9月,共搜集相关文献325篇,对符合纳入标准的病例对照试验,分为实验组RT和对照组RH,并采用RevMan5.2软件进行Meta分析,对于无对照临床研究资料,采用描述性合并分析。结果共纳入8篇病例对照研究和45篇无对照临床研究,Meta分析结果显示RT与RH治疗早期宫颈癌的5年无瘤生存率(OR=0.94,95%CI:0.5—1.78,P=0.85)、5年总生存率(OR=0.67,95%CI:0.27—1.67,P=0.39)及术后并发症(OR=0.65,95%CI:0.41-1.02,P=0.06)差异均无统计学意义,输血率(OR=0.33,95%CI:0.21—0.51,P=0.00001)和术中并发症(OR=1.95,95%CI:1.09—3.47,P=0.02)差异均有统计学意义,即输血率较RH低,术中并发症较RH高。无对照临床病例研究文献统计学结果显示行RT后,尝试妊娠例数为504人,妊娠434例次,活产309例次,即妊娠率为86%,活产率为71%。结论RT对于有生育要求的年轻早期宫颈癌患者是一个安全有效的选择,在根除病灶的同时,又保留了患者的生育能力,且提高改善了早期宫颈癌年轻患者的生存质量。展开更多
目的:分析机器人辅助手术治疗早期宫颈癌的围手术期结果及肿瘤学结局。方法:回顾性分析2015年6月—2021年7月在浙江大学医学院附属第一医院行机器人辅助手术的64例宫颈癌患者的临床资料。结果:64例患者均顺利完成手术,无中转开腹病例。...目的:分析机器人辅助手术治疗早期宫颈癌的围手术期结果及肿瘤学结局。方法:回顾性分析2015年6月—2021年7月在浙江大学医学院附属第一医院行机器人辅助手术的64例宫颈癌患者的临床资料。结果:64例患者均顺利完成手术,无中转开腹病例。根据国际妇产科联盟的临床分期标准,其中ⅠA1期伴淋巴脉管间隙浸润(Lymphovascular Space Invasion,LVSI)4例,ⅠA2期4例,ⅠB1期51例,ⅠB2期4例,ⅡA1期1例。所有患者平均手术时间为(310.56±71.22)min,平均术中失血量为(144.53±92.75)ml,平均切除淋巴结数量为(23.11±6.97)个,平均住院时间为(12.27±3.44)d,平均随访时间为(46.48±15.91)个月(3例失访)。总计30例患者接受术后辅助治疗,其中13例接受同步放化疗,15例接受放疗,2例接受化疗。随访至今,共61例患者存活,其中仅1例患者复发。结论:机器人手术系统在宫颈癌手术中的应用有良好的临床疗效,可以作为治疗早期宫颈癌的有效方法。展开更多
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Radical trachelectomy (RT) is a fertility-sparing treatment for young women with early-stage cervical cancer. We report here a case of a 30-year-old nulliparous woman who presented with stage IA2 cervical squamous cancer. She was treated with total laparoscopic radical trachelectomy (TLRT) and laparoscopic pelvic lymphadenectomy (LPL). During this procedure, the ascending branches of uterine arteries were preserved. No metastasis was identified after fourteen months of follow-up. The menstrual pattern normalized and the patient has been attempting to conceive for two months.TLRT might be a safe fertility-preserving procedure for early-stage cervical cancer, due to its minimally invasive nature and shorter recovery time. However, more data are required on recurrence rate, fertility rate and pregnancy outcome in order to fully evaluate the therapeutic efficacy of TLRT.
文摘目的分析早期宫颈癌患者行根治性宫颈切除术(RT)和根治性全子宫切除术(RH)后5年无瘤生存率及5年总生存率(即以病人从确诊后再经治疗生存5年的病人数占同期病人总数的百万分比衡量疗效),术中和术后并发症、输血率及RT后的妊娠结局。方法应用电子计算机检索PubMed数据库,Cochrane图书馆(2014)、ISI Web of Knowledge、OVID、web.science、Ebsco-medline、超星Medalink、万方、CNKI等数据库并辅以手工检索相关期刊,截止2014年9月,共搜集相关文献325篇,对符合纳入标准的病例对照试验,分为实验组RT和对照组RH,并采用RevMan5.2软件进行Meta分析,对于无对照临床研究资料,采用描述性合并分析。结果共纳入8篇病例对照研究和45篇无对照临床研究,Meta分析结果显示RT与RH治疗早期宫颈癌的5年无瘤生存率(OR=0.94,95%CI:0.5—1.78,P=0.85)、5年总生存率(OR=0.67,95%CI:0.27—1.67,P=0.39)及术后并发症(OR=0.65,95%CI:0.41-1.02,P=0.06)差异均无统计学意义,输血率(OR=0.33,95%CI:0.21—0.51,P=0.00001)和术中并发症(OR=1.95,95%CI:1.09—3.47,P=0.02)差异均有统计学意义,即输血率较RH低,术中并发症较RH高。无对照临床病例研究文献统计学结果显示行RT后,尝试妊娠例数为504人,妊娠434例次,活产309例次,即妊娠率为86%,活产率为71%。结论RT对于有生育要求的年轻早期宫颈癌患者是一个安全有效的选择,在根除病灶的同时,又保留了患者的生育能力,且提高改善了早期宫颈癌年轻患者的生存质量。
文摘目的:分析机器人辅助手术治疗早期宫颈癌的围手术期结果及肿瘤学结局。方法:回顾性分析2015年6月—2021年7月在浙江大学医学院附属第一医院行机器人辅助手术的64例宫颈癌患者的临床资料。结果:64例患者均顺利完成手术,无中转开腹病例。根据国际妇产科联盟的临床分期标准,其中ⅠA1期伴淋巴脉管间隙浸润(Lymphovascular Space Invasion,LVSI)4例,ⅠA2期4例,ⅠB1期51例,ⅠB2期4例,ⅡA1期1例。所有患者平均手术时间为(310.56±71.22)min,平均术中失血量为(144.53±92.75)ml,平均切除淋巴结数量为(23.11±6.97)个,平均住院时间为(12.27±3.44)d,平均随访时间为(46.48±15.91)个月(3例失访)。总计30例患者接受术后辅助治疗,其中13例接受同步放化疗,15例接受放疗,2例接受化疗。随访至今,共61例患者存活,其中仅1例患者复发。结论:机器人手术系统在宫颈癌手术中的应用有良好的临床疗效,可以作为治疗早期宫颈癌的有效方法。