17例局部复发子宫颈癌患者行盆腔廓清术的围手术期情况及近期疗效分析  

Outcomes of perisurgery and short-time follow-up of pelvic exenteration for 17 cases with locally recurrent cervical cancer

作　　者：邓浩[1] 王建六[1] 王志启[1] 李晓伟[1] 胡浩[2] 杨波[2] 张学民[3] 沈凯[4] 郭鹏[4] 梁斌[4] Deng Hao;Wang Jianliu;Wang Zhiqi;Li Xiaowei;Hu Hao;Yang Bo;Zhang Xuemin;Shen Kai;Guo Peng;Liang Bin(Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing 100044,China;Department of Urology,Peking University People's Hospital,Beijing 100044,China;Department of Vascular Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Gastroenterological Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院妇产科,100044 [2]北京大学人民医院泌尿科,100044 [3]北京大学人民医院血管外科,100044 [4]北京大学人民医院胃肠外科,100044

出　　处：《中华妇产科杂志》2020年第4期259-265,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家科技支撑计划(2015BAI13B00)。

摘　　要：目的 探讨局部复发子宫颈癌患者行盆腔廓清术的围手术期情况及近期效果。方法 收集2015年10月-2018年5月北京大学人民医院行盆腔廓清术的局部复发子宫颈癌患者共17例,回顾性分析其临床病理特点、手术情况、住院费用、术后并发症及生存情况。结果 (1)17例局部复发子宫颈癌患者的中位年龄为51岁(27~64岁);病理类型:鳞癌13例,腺癌2例,腺鳞癌2例;初次治疗时13例接受了放疗、4例未放疗。(2)17例局部复发子宫颈癌患者均行盆腔廓清术,其中行全盆腔廓清术(包括膀胱、部分输尿管、直肠及部分阴道)9例、前盆腔廓清术(包括膀胱、部分输尿管及部分阴道)8例,17例患者均顺利完成手术;中位手术时间为450 min(240~760 min),中位术中出血量为2 200 ml(200~8 400 ml),中位术后住院时间为17 d(9~55 d),中位住院费用为83 857元(41 588~296 354元)。(3)17例行盆腔廓清术的患者中,16例出现早期并发症,最常见者为发热(14例);14例出现晚期并发症,最常见者为泌尿系统感染(12例)。(4)17例行盆腔廓清术患者的中位总生存时间为26.0个月(3~44个月);中位无瘤生存时间为9.0个月(2~44个月),其中13例初次治疗接受放疗患者的中位无瘤生存时间为9.0个月(2~30个月),4例初始治疗未放疗患者的中位无瘤生存时间10.5个月(2~44个月),两者比较,差异无统计学意义(P=0.820);11例患者在盆腔廓清术后接受了辅助治疗,中位无瘤生存时间为12.0个月(2~44个月),6例患者未接受术后辅助治疗,中位无瘤生存时间为5.0个月(2~9个月),两者比较,差异无统计学意义(P=0.018)。结论 盆腔廓清术的手术范围大、术后并发症多、住院费用高,术后接受辅助治疗可改善部分患者的无瘤生存时间,其临床价值和卫生经济学价值有待进一步探讨。Objective To investigate the perioperative situation and recent effect of pelvic exenteration for patients with locally recurrent cervical cancer.Methods A total of 17 patients with locally recurrent cervical cancer who underwent pelvic exenteration in Peking University People's Hospital from October 2015 to May 2018 were retrospectively analyzed for their clinical and pathological characteristics,surgical conditions,hospitalization costs,postoperative complications,and survival situation.Results(1)The median age of 17 patients with locally recurrent cervical cancer was 51 years(range 27-64 years).Pathological type:13 cases of squamous cell carcinoma,2 cases of adenocarcinoma,and 2 cases of adenosquamous carcinoma.Thirteen patients received radiotherapy during the initial treatment and 4 patients did not receive radiotherapy.(2)Pelvic exenteration was performed in 17 patients with locally recurrent cervical cancer,of which 9 cases were performed with total pelvic exenteration(operation range including radical cystectomy,partial urethrectomy rectectomy and partial vaginalectomy),and 8 cases with anterior pelvic exenteration operation(operation range including:radical cystectomy,part of urethrectomy and part of vaginalectomy).Of the 17 patients successfully completed the operation.The median operation time was 450 minutes(range 240-760 minutes),the median intraoperative blood loss was 2200 ml(range 200-8400 ml),the median postoperative hospital stay was 17 days(range 9-55 days),the median hospital cost was 83857 yuan(range 41588-296354 yuan).(3)Of the 17 patients underwent pelvic exenteration,16 of them had early complications,the most common one was fever(14 cases).Fourteen of them had late complications,and the most common one was a urinary system infection(12 cases).(4)The median overall survival time was 26.0 months(range 3-44 months),the median progression-free survival(PFS)time was 9.0 months(range 2-44 months).Among them,13 patients received radiation therapy during the initial treatment,the median PFS time

关 键 词：肿瘤复发 局部 宫颈肿瘤 盆腔廓清术 随访研究 

分 类 号：R737[医药卫生—肿瘤]