ⅡA1期子宫颈癌腹腔镜手术安全性评估  

Safety evaluation of laparoscopic radical hysterectomy for stageⅡA1 cervical cancer

作　　者：刘萍[1] 唐连 赵卫东[2] 杨颖 王武亮[4] 王绍光[5] 郝敏[6] 湛雪梅 朱斌 姜文轩 兰俊 梁诗琪 宾小农 郎景和 陈春林[1] LIU Ping;TANG Lian;ZHAO Wei-dong;YANG Ying;WANG Wu-liang;WANG Shao-guang;HAO Min;ZHAN Xue-mei;ZHU Bin;JIANG Wen-xuan;LAN Jun;LIANG Shi-qi;BIN Xiao-nong;LANG Jing-he;CHEN Chun-lin(不详;Department of Obstetrics&Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院妇产科,广州510515 [2]安徽省肿瘤医院妇科 [3]陆军军医大学新桥医院妇产科 [4]郑州大学附属第二医院妇产科 [5]烟台毓璜顶医院妇科 [6]山西医科大学附属第二医院妇科 [7]江门市中心医院妇科 [8]杭州医学院附属义乌妇幼医院妇科 [9]广州医科大学公共卫生学院流行病学系 [10]北京协和医院妇产科

出　　处：《妇产与遗传（电子版）》2022年第4期1-8,共8页Obstetrics-Gynecology and Genetics (Electronic Edition)

摘　　要：目的探讨ⅡA1期子宫颈癌腹腔镜对比开腹手术的肿瘤学结局及严重并发症。方法该研究是基于真实世界数据的多中心回顾性队列研究,纳入2004年至2016年在中国内地37家医院行腹腔镜或开腹QM-B或QM-C型子宫切除的ⅡA1期子宫颈癌患者,比较腹腔镜与开腹组的肿瘤学结局及严重并发症。结果从46313例中国子宫颈癌临床诊疗大数据库中按入组和排除标准纳入4689例ⅡA1期子宫颈癌患者,其中有生存结局的3595例。真实世界数据分析显示腹腔镜组(n=936)5年总体生存率及无瘤生存率均低于开腹组(n=2659)(总体生存率:80.8%vs 88.2%,P=0.022;无瘤生存率:77.8%vs 81.8%,P=0.009),两组1∶2倾向评分匹配后的结果与真实世界数据相符。严重并发症分析时纳入4689例ⅡA1期子宫颈癌,真实世界数据分析显示腹腔镜组(n=1187)的总严重并发症(5.6%vs 2.5%,P<0.001)明显多于开腹组(n=3502)。分类分析显示腹腔镜组术中严重并发症(P<0.001)及术后严重并发症(P<0.001)明显多于开腹组,两组手术部位并发症无差异(P>0.05)。二分类logistic回归分析显示,ⅡA1期子宫颈癌腹腔镜广泛性子宫切除是术中及术后严重并发症发生的独立危险因素(HR=2.079,95%CI 1.131~3.819,P=0.018;HR=2.019,95%CI 1.156~3.526,P=0.014),但腹腔镜不影响手术部位严重并发症的发生(P>0.05)。结论在ⅡA1期子宫颈癌手术治疗中,无论是从肿瘤学结局还是从手术严重并发症角度来看,腹腔镜手术都不是一个好的选择。Objective To explore the oncology outcomes and serious complications for laparoscopic radical hysterectomy versus abdominal radical hysterectomy of stageⅡA1 cervical cancer.Methods Retrospective analysis was performed on patients with stageⅡA1cervical cancer who underwent laparoscopic or open QM-B or QM-C hysterectomy in 37 hospitals in China's Mainland from 2004 to 2016,the outcomes and complications of laparoscopic group and abdominal group were compared.Results 4689 patients with stageⅡA1 cervical cancer were selected from the Chinese cervical cancer database of 46313 cases according to the inclusion criteria.In the survival analysis,1094 cases without survival outcome were excluded,3595 cases were included in the analysis.Analysis of real word data showed that the 5year overall survival(OS)and diseasefree survival(DFS)in the laparoscopic(n=936)group were lower than those in the abdominal(n=2659)group(OS:80.8%vs 88.2%,P=0.022;DFS:77.8%vs 81.8%,P=0009),1∶2 Propensity Score Matching results were consistent.All 4689 cases of stageⅡA1 cervical cancer were included in the analysis of severe complications.Real world data analysis showed that the total serious complications in the laparoscopic group(5.6%vs 2.5%,P<0.001)were significantly higher than those in the abdominal group.Classification analysis showed that intraoperative severe complications(P<0.00)and postoperative severe complications(P<0.00)in the laparoscopic group were significantly higher than those in the abdominal group,no difference in surgical site complications between the two groups.Multivariate logistic regression analysis showed that laparoscopy was an independent risk factor for intraoperative and postoperative severe complications(HR=2.079,95%CI 1.131~3.819,P=0.018;HR=2.019,95%CI 1.156~3.526,P=0.014)in stageⅡA1 cervical cancer,but it did not affect the occurrence of severe complications at the surgical site(P>0.05).Conclusions Laparoscopic radical hysterectomy is not a good choice in the stageⅡA1 cervical cancer,either from the pe

关 键 词：宫颈肿瘤 腹腔镜 开腹 生存结局 并发症 

分 类 号：R737.3[医药卫生—肿瘤]