793例ⅠB1期宫颈癌PiverⅡ型与Ⅲ型手术临床效果比较  

Comparison of clinical effect between Piver typeⅡand Piver typeⅢin 793 cases ofⅠB1 stage cervical cancer

作　　者：高媛[1] 张维娜[1] 郭丽[1] 孙颖[1] 李秦宇琦 宋春雷[2] GAO Yuan;ZHANG Wei-na;GUO Li;SUN Ying;LI QIN-yuqi;SONG Chun-lei(Qingdao Municipal Hospital,Qingdao 266011,P.R.China)

机构地区：[1]青岛市市立医院妇科,山东青岛266011 [2]青岛市市立医院急诊外科,山东青岛266011

出　　处：《中华肿瘤防治杂志》2019年第12期867-870,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的ⅠB1期宫颈癌传统标准术式为PiverⅢ型子宫切除术,此手术创伤大,术后膀胱直肠功能障碍发生率高。本研究通过比较PiverⅡ型与Ⅲ型子宫切除对手术参数及病理参数影响,探讨缩小ⅠB1期宫颈癌宫旁切除范围可行性。方法回顾性分析2005-01-01-2015-12-31青岛市市立医院收治的793例ⅠB1期宫颈癌患者临床资料,入组患者均实施广泛性子宫切除术+盆腔淋巴结清除术(部分患者同时清除腹主动脉旁淋巴结),其中211例患者行PiverⅡ型子宫切除,582例实施PiverⅢ型子宫切除,比较2组手术参数及病理参数。结果PiverⅡ组手术时间为(195.37±46.23)min,少于PiverⅢ组的(215.60±71.56)min,差异有统计学意义,t=3.626,P<0.001;PiverⅢ组腹腔镜使用比例(72.3%)高于PiverⅡ组(53.6%),差异有统计学意义,χ^2=24.839,P<0.001;PiverⅢ组腹主动脉旁淋巴结切除比例(10.0%)高于PiverⅡ组(4.3%),差异有统计学意义,χ^2=6.505,P=0.011。2组术中失血量(t=0.860,P=0.379)、清除淋巴结数量(t=1.161,P=0.265)和术中并发症(χ^2=0.016,P=0.889)差异无统计学意义。PiverⅡ组手术后尿管拔除时间为(9.91±5.33)d,早于PiverⅢ组(12.17±5.66)d,差异有统计学意义,t=4.793,P<0.001,术后排气(t=1.832,P=0.062)及排便时间(t=1.548,P=0.137)差异无统计学意义。ⅠB1期宫颈癌术后盆腔及腹主动脉旁淋巴结转移率分别为11.9%和4.5%,宫旁浸润率为1.3%,阴道切缘阳性率为1.2%,淋巴脉管浸润率为21.0%,宫颈深间质浸润率为55.0%。PiverⅡ组阴道切缘阳性率为2.5%,高于PiverⅢ组(0.7%),差异有统计学意义,χ^2=3.916,P=0.048,而淋巴结转移(χ^2=0.658,P=0.417)、宫旁浸润(χ^2=0.930,P=0.335)、淋巴脉管浸润(χ^2=0.472,P=0.492)和宫颈间质浸润(χ^2=0.227,P=0.634)差异均无统计学意义。结论PiverⅡ型手术治疗ⅠB1期宫颈癌近期疗效优于PiverⅢ型,ⅠB1期宫颈癌宫旁转移率很低,缩小宫旁组织切除范围安全可行,但阴道切除范围不能缩�OBJECTIVE The traditional standard surgical procedure for cervical cancer in stageⅠB1 is PiverⅢhysterectomy.This type of operation can cause great damage and high incidence of bladder and rectal dysfunction to patients.The purpose of this research was to compare the effects on surgical parameters between PiverⅡandⅢhysterectomy,to explore the feasibility of narrowing the range of parastomal resection in stageⅠB1 cervical cancer.METHODS The clinical data of 793 patients with stageⅠB1 cervical cancer were analyzed retrospectively,the data came from Qingdao Municipal Hospital from January 1,2005 to December 31,2015.All patients in the group were treated with radical hysterectomy and pelvic lymphadenectomy(partial patients with para-aortic lymphadenectomy at the same time).PiverⅡhysterectomy was performed in 211 patients and PiverⅢhysterectomy was performed in 582 patients.Surgical parameters and pathological parameters were compared between the two groups.RESULTS To compare the clinical parameters of the two groups,the operation time of PiverⅡgroup was short(t=3.626,P<0.001).PiverⅢhysterectomy was performed under laparoscopy(χ^2=24.839,P<0.001)and the proportion of para-aortic lymphadenectomy was high(χ^2=6.505,P=0.011).There was no statistically significant difference in intraoperative blood loss(t=0.860,P=0.379),the number of lymph node dissection(t=1.161,P=0.265)and intraoperative complications(χ^2=0.016,P=0.889)between the two groups.Compared with the postoperative clinical parameters,in PiverⅡcatheter was removed earlier than in the PiverⅢgroup(t=4.793,P<0.001),and there was no statistically significant difference in postoperative exhaust(t=1.832,P=0.062)and defecation time(t=1.548,P=0.137).Postoperative pathological parameters of cervical cancer in stageⅠB1:the rate of pelvic lymph node metastasis,para-aortic lymph node metastasis,parametrial involvement,positive vaginal incisal margin,lymph vascular space invasion,cervical stromal deep invasion were 11.9%,4.5%,1.3%,1.2%,21.0%and 55

关 键 词：宫颈癌 广泛性子宫切除 病理 宫旁转移 切缘阳性 

分 类 号：R737.33[医药卫生—肿瘤]