1895年，Wertheim提出针对宫颈癌患者的广泛全子宫切除术(ETH)；1930年，Meigs在此基础上改良并提出盆腔淋巴清扫术。当时对于宫颈癌患者由于缺乏早期筛查和放疗等有效辅助治疗手段，主张扩大手术范围，但是引发患者术后诸多并发症。21世纪以来，多项回顾性分析结果表明，低危型早期宫颈癌患者的宫旁转移率低，这为此类患者采取保守的保留生育功能手术(FSS)治疗措施提供了理论依据。2010年启动的ConCerv研究和2012年启动的SHAPE研究，进一步探索对低危型早期宫颈癌患者FSS的可行性和安全性。虽然ConCerv研究结果显示FSS治疗可能安全、可行，但是缺少对照组；SHAPE研究通过大样本随机对照试验证实，筋膜外全子宫切除术，在低危型早期宫颈癌患者中不增加盆腔复发率，而且在治疗相关并发症和患者术后生活质量方面，均优于宫颈癌ETH。但是，笔者认为目前直接将上述2项研究成果应用于临床为时尚早。准确定位低危型早期宫颈癌患者迄今尚存在困难，究其原因是对肿块直径和间质浸润深度判断存在误差，而且对于淋巴血管间隙浸润(LVSI)是否为导致其宫旁转移的高危因素，迄今亦尚无定论。对于低危型早期宫颈癌患者，建议术前需要先进行宫颈锥切术，再对切除组织的组织病理学检查结果进行评估，同时结合盆腔MRI对患者进行辅助评估。上述2项研究虽证实低危型早期宫颈癌FSS的可行性和安全性，但是笔者认为改变传统临床实践仍需谨慎。对于要求保留生育功能的低危型早期宫颈癌患者，FSS可能使其获益。但是，由于中国宫颈癌患者平均发病年龄较晚，对于无保留生育功能需求患者，因此FSS的实际意义可能并不大。为了更好回答"低危型早期宫颈癌患者手术渐趋保守，我们应该如何应对"，笔者期待更多临床研究完善现有对低危型早期宫颈癌患者采取FSS治疗研究的不足，进一步明确FSS在低危型早期宫颈癌患者中的临床作用。

Wertheim proposed the extensive total hysterectomy (ETH) in 1895, and in 1930, Meigs further refined this approach by proposing pelvic lymphadenectomy. At that time, due to the absence of screening approach and effective adjuvant therapies such as radiotherapy, surgeons favored expanding the surgical extent; however, this approach was associated with a high incidence of complications. In the early 21st century, several retrospective studies demonstrated that parametrial metastasis rates were relatively low in low-risk early-stage cervical cancer, providing a theoretical foundation for fertility-sparing surgery (FSS) approaches. The ConCerv study, initiated in 2010, and the SHAPE study, launched in 2012, further investigated the feasibility and safety of FSS for low-risk early-stage cervical cancer. While the ConCerv study suggested that FSS might be safe and feasible, this study lacked a control group. Moreover, the SHAPE study, through a large-scale randomized controlled trial, confirmed that extrafascial total hysterectomy did not increase the pelvic recurrence rate in low-risk early-stage cervical cancer and offered advantages over radical surgery in terms of complications and quality of life. Nevertheless, directly translating these findings into clinical practice remains premature. Accurately identifying low-risk cervical cancer patients preoperatively poses challenges, such as inaccuracies in assessing tumor size and depth of stromal invasion. Additionally, whether lymphovascular space invasion (LVSI) constitutes a high-risk factor remains unclear. It is recommended to perform cervical conization for pathological evaluation prior to FSS and utilize MRI for auxiliary assessment. Although both studies validated the feasibility and safety of FSS for low-risk early-stage cervical cancer, caution is warranted when considering changing traditional clinical practices. For fertility-sparing patients, FSS may offer benefits; however, for non-fertility-sparing patients, given the relatively late average age of onset of cervical cancer in China, the practical significance of FSS may be limited. Further clinical research is anticipated to address the limitations of existing studies and elucidate the role of FSS more clearly.