不同阴道切开路径对行腹腔镜根治性手术的Ⅰa2~Ⅱa2期子宫颈癌患者预后及复发转移部位的影响  

Effects of colpotomic approaches on prognosis and recurrence sites of stageⅠa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy

作　　者：周丹 李宇迪 凌开建 王瑞伟 王延洲 唐帅 梁志清 Zhou Dan;Li Yudi;Ling Kaijian;Wang Ruiwei;Wang Yanzhou;Tang Shuai;Liang Zhiqing(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院妇产科,重庆400038

出　　处：《中华妇产科杂志》2023年第1期49-59,共11页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2019YFC1005202);重庆市社会事业与民生保障科技创新专项(cstc2016shms-ztzx10001)。

摘　　要：目的探究影响Ⅰa2~Ⅱa2期子宫颈癌腹腔镜根治性手术患者预后的相关因素,并比较不同阴道切开路径患者的预后及复发转移部位的差异。方法收集2015年1月至2018年12月于陆军军医大学第一附属医院接受腹腔镜根治性手术的965例Ⅰa2~Ⅱa2期子宫颈癌患者的临床病理资料,患者的中位年龄为47.0岁,所有患者均随访,中位随访时间为62个月(48~74个月)。采用Cox比例风险模型对可能影响子宫颈癌患者预后[包括无复发生存率(DFS)和总生存率(OS)]的临床病理因素进行单因素分析和多因素分析。阴道切开路径分为两种:关闭气腹后经阴道钳夹子宫颈并下拉后切开阴道穹隆(经阴道组,475例),在腹腔镜气腹条件下经腹切开阴道穹隆(经腹腔镜组,490例);进一步对不同阴道切开路径子宫颈癌患者的预后及复发转移部位进行比较。结果(1)965例子宫颈癌患者中,随访期内复发137例(14.2%,137/965),死亡98例(10.2%,98/965);患者的5年DFS和OS分别为85.8%和89.9%。单因素分析显示,临床分期、肿瘤最大径、病理分化程度、淋巴结转移状态、肌层浸润深度、宫旁浸润、宫体浸润均是显著影响子宫颈癌患者5年DFS和OS的因素(P均<0.05),阴道切缘状态是显著影响子宫颈癌患者5年OS的因素(P=0.023)。多因素分析显示,临床分期(HR=1.882,95%CI为1.305~2.716)、淋巴结转移状态(HR=2.178,95%CI为1.483~3.200)、宫体浸润状态(HR=3.650,95%CI为1.906~6.988)均是显著影响Ⅰa2~Ⅱa2期子宫颈癌患者5年DFS的独立因素(P均<0.001);临床分期(HR=2.500,95%CI为1.580~3.956)、淋巴结转移状态(HR=2.053,95%CI为1.309~3.218)、宫体浸润状态(HR=3.984,95%CI为1.917~8.280)、阴道切缘状态(HR=3.235,95%CI为1.021~10.244)均是显著影响Ⅰa2~Ⅱa2期子宫颈癌患者5年OS的独立因素(P均<0.05)。(2)不同阴道切开路径不影响Ⅰa2~Ⅱa2期子宫颈癌患者的5年DFS和OS,经阴道组和经腹腔镜组患者的5年DFS分别为85.9%Objective To investigate the factors affecting the prognosis of stageⅠa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy(LRH),and to compare the prognosis and recurrence sites of patients with different colpotomy paths.Methods The clinical data of 965 patients with stageⅠa2-Ⅱa2 cervical cancer who underwent LRH in the First Affiliated Hospital of Army Medical University from January 2015 to December 2018 were collected.The median age was 47.0 years of all patients with a median follow-up of 62 months(48-74 months).Cox regression was used to perform the univariate and multivariate analysis of the clinicopathological factors associated with the prognosis that included disease-free survival(DFS)and overall survival(OS).Patients were categorized into LRH through vaginal colpotomy(VC group,n=475)and LRH through intracorporeal colpotomy(IC group,n=490)according to the colpotomic approaches.The prognosis and recurrence sites of patients in each group were compared.Results(1)During the follow-up period,137 cases recurred(14.2%,137/965)and 98 cases died(10.2%,98/965).The 5-year DFS and OS were 85.8%and 89.9%,respectively.In univariate analysis,positive vaginal margin(PVM)was significantly affected the 5-year OS of patients with cervical cancer(P=0.023),while clinical stage,maximum diameter of tumor,degree of pathological differentiation,lymph node metastasis(LNM),depth of cervical stromal invasion,parametrium involvement,and uterine corpus invasion(UCI)were significantly associated with 5-year DFS and OS in patients with cervical cancer(all P<0.05).In multivariate analysis,clinical stage(HR=1.882,95%CI:1.305-2.716),LNM(HR=2.178,95%CI:1.483-3.200)and UCI(HR=3.650,95%CI:1.906-6.988)were independent risk factors of 5-year DFS(all P<0.001).Clinical stage(HR=2.500,95%CI:1.580-3.956),LNM(HR=2.053,95%CI:1.309-3.218),UCI(HR=3.984,95%CI:1.917-8.280),PVM(HR=3.235,95%CI:1.021-10.244)were independent risk factors of 5-year OS(all P<0.05).(2)Different colpotomy paths did not significantly affect the 5-year DFS and

关 键 词：宫颈肿瘤 腹腔镜检查 子宫切除术 阴道式 肿瘤复发 局部 预后 

分 类 号：R737.33[医药卫生—肿瘤]