年轻的早期子宫颈癌患者行不同方式的子宫颈广泛性切除术后的安全性和生育情况及复发因素分析  

Analysis of the security, pregnancy outcomes, and the tumor recurrence related factors of young patients with cervical cancer treated with different radical trachelectomy

作　　者：陈亦乐[1] 李乐赛[1] 唐真姿[1] 唐迪红[1] 肖辉[1] 朱珠[1] 

机构地区：[1]中南大学湘雅医学院附属肿瘤医院妇瘤科,长沙410013

出　　处：《中华妇产科杂志》2013年第5期352-357,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨年轻的早期（Ia1～Ib1期）子宫颈癌患者行不同方式的宫颈广泛性切除术（RT）后的安全性和生育情况，并分析其复发的相关因素。方法选择2004年5月至2012年7月问在中南大学湘雅医学院附属肿瘤医院行RT的32例年轻（〈40岁）的早期宫颈癌患者的临床资料。根据手术方式的不同将32例患者分为两组：行阴式RT（RVT）＋腹腔镜下盆腔淋巴结切除术（RVT组），共18例；行腹式RT（RAT）＋盆腔淋巴结切除术（RAT组），共14例。采用t检验或∥检验，对两组患者的术中、术后及生育情况进行比较；采用单因素方差分析和多因素Cox逐步回归法，对早期宫颈癌患者复发的相关因素进行分析。结果RVT组患者的手术时间、淋巴结切除数、宫颈切除长度、术后住院时间、血管损伤发生率及术后淋巴囊肿发生率分别为（250±82）min、（15±6）个、（2．31±0．21）cm、（9．2±2．9）d、1／18、1／18，RAT组患者分别为（263±60）rain、（16±8）个、（2．32±0．26）cm、（10．3±3．5）d、0、1／14，两组间分别比较，差异均无统计学意义（P〉0．05）；RVT组患者的术中出血量[（281±201）m1]明显低于RAT组[（492±320）ml；P〈O．05]，阴道切除长度及宫旁组织切除宽度[分别为（2．61±0．50）、（2．38±0．36）em]均明显小于RAT组[分别为（2．95±0．10）、（2．81±0．22）em；P〈0．05]；血管损伤发生率（1／18）明显高于RAT组（0，P〈0．05）。RVT组和RAT组患者术后的妊娠率分别为3／18、2／14，两组比较，差异无统计学意义（P〉0．05）。单因素分析显示，早期宫颈癌患者的复发与肿瘤直径有关（F=4．911，P=0．047），而与年龄、临床分期、病理类型、手术方式无关（P〉0．05）；多因素分析显示，肿瘤直径是早期宫颈癌患者复发的独立危险因素（卢=0．259，P=0．031）。结论对年轻的早期宫颈�Objective To explore the security, pregnancy outcomes, and the tumor recurrence related factors of young patients with cervical cancer treated with different radical trachelectomy （RT）. Methods Thirty-two young patients 〈 40 years of age with early cervical cancer from May 2004 to July 2012 admitted in Tumor Hospital Xiaugya School of Medicine of Central South University were divided into two groups based on different operation methods：vaginal radical trachelectomy （RVT） group and abdominal radical trachelectomy （RAT）group. The clinical data were analyzed by One-way Anova and multivariate Cox stepwise regression analysis. Results The operation duration, number of lymph node dissection, the height of the cervical resection, postoperative hospitalization time, incidence of vascular injury and incidence of postoperative lymphocele were respectively （250±82） rain, 15 ±6, （2. 31±0. 21 ） cm, （9. 2 ±2. 9） d, 1/18 and 1/18 in RVT group, while （263 ＋60） min,16 ±8,（2.32 ±0.26） cm,（10.3 ±3.5） d,0 and 1/14 in RAT group. There was no statistically significant difference between the two groups （all P 〉0.05 ）.The blood loss （281 _＋201 ） ml in RVT group was significantly lower than that in the RAT group （492 _＋ 320） ml （P 〈 0. 05 ）. The length of Vaginal hysterectomy[ （2. 61 _＋ 0. 50） cm ~ and the width of parametrial resection[ （2. 38 ±0. 36） cm] in RVT group were significantly less than those[ （2. 95 ±0. 10）, （2. 81 ± 0. 22） cm] in the RAT group （all P 〈 0. 05 ）. The pregnancy rate between RVT group （3/18） and RAT group （2/14） were no significant difference （P 〉 0. 05）. One-way Anova analysis showed that the recurrence of early cervical cancer was related to tumor size in diameter （ F = 4. 911 ,P = 0. 047 ） , while there were no correlation with age, clinical stage, histological type and surgical approach （ all P 〉 0. 05 ）. Multivariate analysis showed that tumor diameter size was an independent risk fact

关 键 词：宫颈肿瘤 子宫颈 妇科外科手术 保留生育能力 肿瘤复发 局部 

分 类 号：R737.33[医药卫生—肿瘤]