早期宫颈癌经阴道宫颈广泛切除术＋腹膜外盆腔淋巴结清扫术后3～5年临床观察研究

doi:10.3877/cma.j.issn.1673-5250.2010.04.011

目的

探讨早期宫颈癌年轻患者保留生殖生理功能的可行性及潜在风险。

方法

2003年1月至2005年6月，在杭州师范大学医学院附属萧山第一人民医院妇产科确诊为宫颈癌，经国际妇产科联盟(International Federation of Gynecology and Obstetrics，FIGO)临床分期为Ⅰ期(Ⅰ_a～Ⅰ_b)，并自愿要求保留子宫以维持生殖生理功能(术前结合病情综合考虑有保留生殖生理功能条件)的9例患者，实施经阴道宫颈广泛切除术＋腹膜外盆腔淋巴结清扫术(本研究程序符合杭州师范大学医学院附属萧山第一人民医院制定的伦理学标准，得到该委员会批准，并与受试者签署临床研究知情同意书)。患者在全身麻醉或双持硬膜外麻醉下，经腹膜外，分别清扫双侧髂总、髂外、髂内、闭孔、腹股沟深及腹股沟浅等各组淋巴结，切除组织送冰冻病理学检查。

结果

9例患者中，除1例在手术后13个月阴道残端刮片发现癌细胞，给予放疗外，其余8例患者已无癌生存3～5年。

结论

对早期宫颈癌年轻患者行经阴道宫颈广泛切除＋盆腔淋巴结清扫术在近、中期是安全的，对维持生殖生理功能具重要意义，但远期效果尚待进一步观察和研究。

关键词: 早期宫颈癌, 经阴道宫颈广泛切除术, 疗效观察

Objective

To explore the feasibility and potential risks of fertility preservation for young patients with early cervical cancer.

Methods

From January 2003 to June 2005, 9 cases with early cervical cancer Ⅰ_a-Ⅰ_b(International Federation of Gynecology and Obstetrics, FIGO) who demanded preservation of child-bearing potentials or physiological functions underwent transvaginal radical trachelectomy + pelvic lymphadenectomy with general anesthesia or double continuous epidural anesthesia. Informed consent was obtained from all participants. The common iliac, external iliac internal iliac nodes, obturator, superficial, and deep groin lymph nodes were dissected extra-peritonially and carried out by frozen-section examination. Cervical tissues were carried out by frozen-section examinations.

Results

No complications were found. Follow-up for 3-5 years, 8 cases were tumor-free survival and 1 was found cancer cells on the vaginal apiculus at 13th month after operation, and she received radiotherapy.

Conclusion

In the near future, vaginal radical trachelectomy+ pelvic lymphadenectomy is a safe method for patients with early cervical cancer, however, its long-term effects need further study.

Key words: early cervical cancer, vaginal radical trachelectomy, therapeutic effect observation

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Three to Five Years Clinical Evaluation of Early Cervical Cancer After Transvaginal Radical Trachelectomy Plus Pelvic Lymphadenectomy

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Three to Five Years Clinical Evaluation of Early Cervical Cancer After Transvaginal Radical Trachelectomy Plus Pelvic Lymphadenectomy