从妇科肿瘤医生角度看子宫颈癌腹腔镜手术  

How to see laparoscopic surgery for cervical cancer from the perspective of a gynecological oncologist

作　　者：王登凤 张国楠 WANG Deng-feng;ZHANG Guo-nan(Gyne?cologic Oncology Center,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,China)

机构地区：[1]电子科技大学医学院附属肿瘤医院四川省肿瘤医院妇科肿瘤中心,四川成都610041

出　　处：《中国实用妇科与产科杂志》2020年第4期313-317,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：四川省医学重点学科建设项目(川卫办发【2007】407号)。

摘　　要：广泛性子宫切除术+盆腔淋巴结清扫术是早期子宫颈癌的标准治疗方式。由于腹腔镜手术在围手术期结局上的优势,且肿瘤治疗结局与开腹手术相似,逐渐成为早期子宫颈癌的主要手术方式之一。直到2018年11月,《新英格兰医学杂志》发表了2项临床研究结果显示,与开腹手术相比,微创手术的复发率更高、生存期更短。这使得子宫颈癌的微创手术受到了前所未有的打击。而2019年12月《妇科肿瘤学杂志》发表的一项大数据回顾性分析研究结果无疑对于子宫颈癌微创手术是雪上加霜的考验,该研究结果显示,与开腹组相比,腹腔镜组的手术相关并发症发生率更高。文章将从妇科肿瘤医生视角就无瘤原则、无瘤技术及腹腔镜操作细节等方面进行分析及建议。Radical hysterectomy(RH)with bilateral pelvic lymph node dissection is recommended as the standard treatment for early-stage cervical cancer.Compared with open surgery,minimally invasive surgery(MIS)has some advantages in perioperative outcomes and comparable prognosis,so MIS has been adopted as an optimal treatment for early cervical cancer.Until November 2018,there were two articles published in The New England Journal of Medicine(NEJM),which reversed the situation.The result suggestedthat,for early-stage cervical cancer patients,MIS group had higher recurrence rates and worse overall survival compared with open surgery group.In December 2019,a retrospective study with a large sample size was published in Gynecologic Oncology,which was undoubtedly an even worse test for MIS.The result showed that compared with the open surgery,the incidence of surgery-related major complications in MIS group was higher.We will analyse and discuss the situation and give some suggestions on tumor-free principle,tumor-free technology and laparoscopic operation details from the perspective of a gynecological oncologist.

关 键 词：子宫颈肿瘤 手术 腹腔镜手术 生存率 复发率 并发症 

分 类 号：R737.3[医药卫生—肿瘤]