探讨对早期宫颈癌患者进行阴式子宫颈广泛切除术(VRT)的临床疗效及生育结局。

选择2008年1月至2014年3月于湖北省黄石市妇幼保健院接受VRT联合腹腔镜盆腔淋巴结切除术治疗的早期宫颈癌患者48例为研究对象。48例患者的中位年龄为29岁；国际妇产科联盟(FIGO)临床分期：Ⅰ_A1期伴淋巴血管间隙受累为5例，Ⅰ_A2期为4例，Ⅰ_B1期为39例；肿瘤直径：无肉眼可见肿瘤为20例，肿瘤直径≤2 cm为20例，>2 cm为8例；病理类型：鳞癌为42例，腺癌或腺鳞癌为6例。排除因盆腔淋巴结受累或子宫颈内口切缘受累，于VRT中改行同步放、化疗者。采用回顾性分析法分析48例成功完成VRT患者的手术相关指标、治疗效果及生育结局。本研究遵循的程序符合湖北省黄石市妇幼保健院人体试验委员会所制定的伦理学标准，得到该委员会批准，并与受试者签署临床研究知情同意书。

①手术相关结果：对48例患者均成功施行VRT而保留生育功能，手术平均时间为(185±35) min；术中平均出血量为(310±131) mL。手术切除的子宫颈平均长度为(2.6±0.6) cm；切除的宫旁组织平均宽度为(1.9±0.5) cm；平均切除淋巴结数为(26±10)枚。②治疗效果：VRT后随访期内6例复发，复发率为12%(6/48)，复发中位时间为20个月。肿瘤直径>2 cm者的复发率显著高于肿瘤直径≤2 cm者，差异有统计学意义(37.5%vs8.0%，χ²＝12.52, P<0.01)；腺癌或腺鳞癌患者的复发率显著高于鳞癌患者，差异有统计学意义(50%vs7%，χ²＝18. 66，P<0.01)。③生育结局：VRT后有生育要求的35例患者中，13例获妊娠17例次，妊娠率为37% (13/35)；9例受试者最终分娩10例新生儿(1例2次足月妊娠并成功分娩2例新生儿)，生育率为26%(9/35)。

VRT联合腹腔镜盆腔淋巴结切除术，可有效保留早期子宫颈癌患者生育功能，部分患者术后可成功妊娠并生育。肿瘤直径>2 cm早期子宫颈癌患者的复发率显著增高，因而VRT的适应证应严格限于肿瘤直径≤2 cm者。

To study prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy (VRT) in combination with laparoscopic pelvic lymphadenectomy.

From January 2008 to March 2013, a total of 48 cases of early cervical cancer patients who received VRT in Huangshi Maternal and Child Health Care Hospital were selected as study subjects. Their median age was 29 years. According to the International Federation of Gynecology and Obstetrics (FIGO) stage of cervical cancer, 5 cases of them were in stage of Ⅰ_A1, 4 cases were in stage of Ⅰ_A2, and 39 cases were in stage of Ⅰ_B1. Among them 20 cases' cervical cancer were not visible to the naked eye, 20 cases' diameters of cervical cancer were equal or less than 2 cm, 8 cases were more than 2 cm. Pathological types of cervical cancer in this group, 42 cases were squamous cell carcinoma, and 6 cases were adenocarcinoma or adenocarcinoma. Pelvic node involvement or the cervical internal jugular margin involvement were excluded. By retrospectively method, the surgical data, disease recurrences and fertility outcomes of 48 cases of early cervical cancer patients were statistically analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Huangshi Maternal and Child Health Care Hospital in Hubei Province. Informed consent was obtained from all participants.

①Forty-eight patients succeeded in preserving fertility by VRT. The mean duration of VRT was (185±35) min, intraoperative mean blood loss volume was (310±131) mL. The mean excised cervical length and parametrial width was (2.6±0.6) cm and (1.9±0.5) cm, respectively. ② Six recurrences (12%) were observed after following up for a mean duration of (35±21) months. The recurrent rate in patients with tumor diameter>2 cm was significantly higher than that of the patients with tumor diameter ≤2 cm (37.5% vs 8.0%, χ²=12.52, P<0.01) and the difference was significantly different. The recurrent rate in patients with adenocarcinoma or squamous cell carcinoma was significantly higher than that of the patients with cervical squamous cell carcinoma (50% vs 7%, χ²=18. 66, P<0.01) and the difference was significantly different. ③Among the 35 patients who desired to conceive after the surgery, 13 women had 17 pregnancies and the pregnant rate was 37.1% (13/35). Nine women obtained 10 healthy live birth babies. The fertility rate was 25.7% (9/35).

VRT combined with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes. Tumor diameter ≤2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor diameter >2 cm.