腹腔镜下以子宫深静脉及其属支为解剖学标志的C1型子宫切除术治疗宫颈癌的临床分析  

Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches for cervical cancer

作　　者：梁美蓉 韩斗星[2] 江维[3] 刘晖[3] 李凌[3] 钟美玲[3] 罗琳[4] 曾四元 Liang Meirong;Han Douxing;Jiang Wei;Liu Hui;Li Ling;Zhong Meiling;Luo Lin;Zeng Siyuan(Medical College of Nanchang University, Nanchang 330006, China;Department of Nephrology, Jiangxi Provincial Children＇s Hospital,Nanchang 330006, China;Department of Gynecologic Oncology, Jiangxi Maternal and Child Health Hospital, Nanchang 330006, China;Department of Pharmacy, Jiangxi Maternal and Child Health Hospital, Nanchang 330006, China)

机构地区：[1]南昌大学医学部,330006 [2]江西省儿童医院肾内科,南昌330006 [3]江西省妇幼保健院肿瘤科,南昌330006 [4]江西省妇幼保健院药剂科,南昌330006

出　　处：《中华肿瘤杂志》2018年第4期288-294,共7页Chinese Journal of Oncology

基　　金：江西省卫生计生委普通科技计划（20161118）

摘　　要：目的评估腹腔镜下以子宫深静脉及其属支为解剖学标志的C1型子宫切除术治疗宫颈癌的可行性和安全性，分析其对膀胱功能的影响。方法选择2010年3月至2015年12月间IA2-ⅡB期子宫颈癌患者，行腹腔镜下以子宫深静脉及其属支为解剖学标志的C1型子宫切除术治疗．对其临床病理特征和预后进行分析。结果99例患者实施了腹腔镜下以子宫深静脉及其属支为解剖学标志的C1型子宫切除术，其中93例患者成功保留了一侧或双侧盆腔自主神经，6例患者因术中粘连、出血以及考虑患者手术切除的根治性，改行c2型子宫切除术，手术失败率为6．1％（6／99）。93例患者的年龄为（44．4±8．2）岁，IA2期1例，IB1期84例，IB2期2例，ⅡA1期5例，ⅡB期1例。鳞癌67例，腺癌19例，腺鳞癌3例，神经内分泌小细胞癌3例，混合类型l例。93例患者的手术时间为（4．1±0．5）h，术中失血量为（103．8±84．0）ml，切除盆腔淋巴结（29．7±8．9）枚，无宫旁切缘阳性、阴道切缘阳性及术中输尿管损伤患者，术后尿管拔除时间为（20．3±8．4）d。全组患者远期膀胱功能障碍的发生率为8．6％（8／93），发生局部未控和远处转移各1例，2例患者均死亡，死亡率为2．2％（2／93）。全组患者的2年无瘤生存率和总生存率分别为97．6％和96．2％。结论腹腔镜下以子宫深静脉及其属支为解剖学标志的C1型子宫切除术治疗宫颈癌安全、可行，为简化腹腔下C1型子宫切除术的手术步骤提供了新的思路。Objective To introduce the laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branched and to evaluate its feasibility and safety for cervical cancer and its effect to bladder function and to provide some reference to simplify the surgical procedures of laparoscopic type C1 hysterectomy. Methods The clinicopathologic data of the patients with stage IA2 Ⅱ B cervical cancer and who underwent the laparoscopic C1 hysterectomy based on anatomic landmark of the uterus deep vein and its branches between March 2010 and December 2015 was retrospectively analysed. Results A total of 99 patients received laparoscopic type C 1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches, in which 93 patients reserved unilateral or bilateral pelvic autonomic nerve successfully, the other 6 patients were transfered to receive type C2 hysterectomy due to adhesions, bleeding or the low possibility of curative resection. The failure rate of the surgery was 6.1% （6/99）.The average age of these 93 patients was 44.4±8.2 years （range 25 -61 years） and there was one case of stage I A2, 84 stage I B1, 2 stage I B2, 5 stage Ⅱ A1 and 1 stage IIB. The number of patients with squamous cell carcinoma was 67, adenocarcinoma was 19, adenosquamous carcinoma was 3, small cell neuroendocrine carcinoma was 3 and mixed type was 1. The average operation time was 4. 1 ± 0.5 h, the average amount of intraoperative blood loss was 103.8 ± 84.0 ml and the mean number of excisional pelvic lymph nodes was 29.7±8.9. There was no patient with positive parametrial margin, positive vaginal margin or intraoperative ureteral injury. The postoperative catheter extraction time was 20.3±8.4 d. The median follow- up time was 20 months （rang 5 ±44 months ）, the long-term bladder dysfunction rate was 8.6% （8/93）. The numbers of locally uncontrolled and distantly metastasis case were both one and both patients died. The fatality rate were 2.2% （2/93）. The two-year disea

关 键 词：宫颈肿瘤 广泛性子宫切除术 保留盆腔自主神经 腹腔镜手术 预后 

分 类 号：R737.33[医药卫生—肿瘤]