早期子宫颈癌行腹腔镜子宫颈广泛性切除术的肿瘤结局分析  

Oncological outcomes of laparoscopic radical trachelectomy for early stage cervical cancer

作　　者：刘青[1] 孙雨欣[1] 刘开江[1] 李培全[1] 赵绚璇 胡郅珺 Liu Qing;Sun Yuxin;Liu Kaijiang;Li Peiquan;Zhao Xuanxuan;Hu Zhijun(Department of Gynecological Oncology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇科肿瘤科,上海200127

出　　处：《中华妇产科杂志》2024年第2期135-142,共8页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨早期子宫颈癌行腹腔镜子宫颈广泛性切除术(LRT)的肿瘤结局。方法收集2014年7月—2023年6月上海交通大学医学院附属仁济医院实施LRT的148例早期子宫颈癌患者的临床病理资料及随访资料,回顾性分析其肿瘤结局及术后妊娠情况。结果(1)一般情况:148例实施LRT患者的中位年龄为33岁(范围:19~42岁);病理类型:鳞癌111例,腺癌36例,腺鳞癌1例;国际妇产科联盟(2018年)分期:Ⅰa1期伴淋巴脉管间隙浸润17例,Ⅰa2期25例,Ⅰb1期102例,Ⅰb2期4例。(2)肿瘤结局:148例患者LRT术后定期随访,中位随访时间为59个月(范围:2~104个月)。随访期内复发5例(其中1例死亡),中位复发时间为10个月(范围:4~33个月);其中盆腔转移3例,远处转移1例,盆腔和远处均有转移1例。148例患者的3年、5年无病生存率均为94.5%,5年总生存率为98.9%。(3)术后妊娠:148例LRT患者中,有妊娠需求且术后满1年的患者67例,其中20例妊娠,妊娠率为29.9%(20/67)。20例妊娠患者中,早孕期流产2例,中孕期流产1例,分娩17例(包括早产4例、足月产13例)。结论在严格掌握手术指征、保证手术范围及术中无瘤操作的情况下,早期子宫颈癌患者行LRT的肿瘤结局良好。Objective To analyze and summarize the oncological outcomes after laparoscopic radical trachelectomy(LRT)for early stage cervical cancer.Methods The clinical data and follow-up results of 148 patients with early stage cervical cancer who underwent LRT in Renji Hospital,School of Medicine,Shanghai Jiao Tong University from July 2014 to June 2023 were collected,while tumor outcomes and postoperative pregnancy were analyzed retrospectively.Results(1)General situation:the median age of 148 patients with LRT was 33 years(range:19-42 years).Pathological type:111 cases of squamous cell carcinoma,36 cases of adenocarcinoma,1 case of adenosquamous carcinoma.International Federation of Gynecology and Obstetrics(2018)stage:17 cases of stageⅠa1 with lympho-vascular space invasion,25 cases of stageⅠa2,102 cases of stageⅠb1,and 4 cases of stageⅠb2.(2)Tumor outcomes:148 patients were followed up regularly after LRT,and the median follow-up time was 59 months(range:2-104 months).During the follow-up period,5 cases of tumor recurred(including 1 death),and the median recurrence time was 10 months(range:4-33 months).Among them,there were 3 cases of pelvic metastasis,1 case of distant metastasis,and 1 case of both pelvic and distant metastasis.Both 3-year and 5-year disease-free survival rates of 148 patients were 94.5%,and the 5-year overall survival rate was 98.9%.(3)Postoperative pregnancy:among 148 patients with LRT,67 patients had pregnancy requirements,followed up for 1 year,and 20 of them were pregnant,with a pregnancy rate of 29.9%(20/67).Among the 20 pregnant patients,2 cases early abortion,1 case mid-term abortion,and 17 cases gave birth(including 4 cases of premature birth and 13 cases of full-term birth).Conclusion Under the condition of strict control of surgical indications,guaranteed surgical scope and tumor-free operation,LRT in patients with early cervical cancer has a good outcome.

关 键 词：宫颈肿瘤 子宫颈切除术 腹腔镜检查 治疗结果 

分 类 号：R737.33[医药卫生—肿瘤]