腹腔镜与腹式广泛性全子宫切除术治疗早期子宫颈癌疗效比较研究  

Comparison of clinical effects of laparoscopic radical hysterectomy and abdominal radical hysterectomy for early cervical cancer

作　　者：李婧[1] 王东雁[1] 刘昀昀[1] 周晖[1] 谢玲玲[1] 林仲秋[1] 卢淮武[1] LI Jing;WANG Dong-yan;LIU Yun-yun;ZHOU Hui;XIE Ling-ling;LIN Zhong-qiu;LU Huai-wu(Department of Gynecological Oncology,Sun Yat-sen Memorial Hospital of Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院妇科肿瘤专科,广东广州510120

出　　处：《中国实用妇科与产科杂志》2021年第10期1044-1048,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金面上项目(81972433);逸仙临床研究培育项目(SYS-C-202001)。

摘　　要：目的探讨腹腔镜下与腹式广泛性全子宫切除术治疗早期子宫颈癌的临床疗效。方法回顾性分析2014年12月至2017年12月在中山大学孙逸仙纪念医院妇科肿瘤专科接受腹腔镜(99例,腹腔镜组)和腹式广泛性全子宫切除术(131例,腹式组)的ⅠA2~ⅠB2期(FIGO 2018)子宫颈癌患者的临床资料,比较两组的手术情况、术后并发症及肿瘤结局。结果腹式组相较于腹腔镜组有更高的切口愈合不良率(8.1%vs.2.0%,P=0.018)及淋巴囊肿发生率(8.4%vs.2.0%,P=0.038),其他近期及远期并发症相较差异无统计学意义。两组间5年总生存率(OS)(96.2%vs.93.9%,P=0.396)和5年无病生存率(DFS)(94.7%vs.89.9%,P=0.160)差异无统计学意义。亚组分析显示,在肿瘤直径≥2cm组(ⅠB2期),两组5年OS相似(96.8%vs.92.2%,P=0.168),但腹腔镜组5年DFS明显下降(87.5%vs.96.8%,P=0.021)。在肿瘤直径<2cm组(ⅠA2+ⅠB1期),腹腔镜和腹式组5年OS(94.6%vs.97.1%,P=0.600)和5年DFS(89.2%vs.94.3%,P=0.452)差异无统计学意义。对肿瘤复发部位分析显示,腹腔镜组盆腔复发率明显增高(5.1%vs.0.8%,P=0.043)。结论对于早期子宫颈癌,腹腔镜广泛性全子宫切除术淋巴囊肿发生率和切口愈合不良率更低,但是盆腔复发率高,在选择腹腔镜手术时需谨慎考虑。腹腔镜广泛性全子宫切除术治疗肿瘤直径≥2cm的患者5年DFS显著降低,提示这种类型的患者接受腹腔镜手术可能是不安全的。Objective To compare the effect of laparoscopic radical hysterectomy(LRH)with that of abdominal radical hysterectomy(ARH)in the treatment of early cervical cancer.Methods Clinical data were retrospectively analyzed in patients with stageⅠA2-ⅠB2(FIGO 2018)cervical cancer,who underwent LRH(n=99)and ARH(n=131)from December 2014 to December 2017 at the Department of Gynecologic Oncology of Sun Yat-sen Memorial Hospital of Sun Yat-Sen University,to compare the surgery,complications and oncological outcomes.Results Findings showed that both the LRH and ARH group were comparable when it came to most short-term and long-term complications,except that there was a higher rate of poor wound healing(8.1%vs.2.0%,P=0.018)and a higher rate of lymphocyte formation(8.4%vs.2.0%,P=0.038)observed in the ARH group.There was no significant difference observed in 5-year overall survival(OS)rate(96.2%vs.93.9%,P=0.396)or the 5-year disease-free survival(DFS)rate(94.7%vs.89.9%,P=0.160)between the two groups.In subgroup analysis,among patients with tumor size≥2 cm(stageⅠB2),the 5-year OS was similar between the two groups(92.2%vs.96.8%,P=0.168);however LRH group had a significantly lower 5-year DFS(87.5%vs.96.8%,P=0.021).There was no significant difference observed in the 5-year OS(94.6%vs.97.1%,P=0.600)or 5-year DFS(89.2%vs.94.3%,P=0.452)for patients with tumor sizes<2 cm(stageⅠA2 andⅠB1)between the two groups.Moreover,the analysis of tumor recurrence site showed that the pelvic recurrence rate of laparoscopic group was obviously higher(5.1%vs.0.8%,P=0.043).Conclusions For early cervical cance,the rate of lymphocyte formation and the rate of poor wound healing were lower in laparoscopic radical hysterectomy.One should still be cautious about selecting LRH due to its association with a higher rate of pelvic recurrence.Because of the significant lower 5-year DFS observed in early-stage patients with tumor sizes more than 2 cm,LRH may be an unacceptable option for those patients.

关 键 词：腹式广泛性全子宫切除术 腹腔镜广泛性全子宫切除术 早期子宫颈癌 总生存率 无病生存率 

分 类 号：R737.3[医药卫生—肿瘤]