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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2021, Vol. 17 ›› Issue (02): 142 -151. doi: 10.3877/cma.j.issn.1673-5250.2021.02.004

Special Issue: ； ；

Interpretation of the Guidelines of the Brazilian Society of Oncologic Surgery for Pelvic Exenteration in the Treatment of Cervical Cancer

Yiran Wang, Ping Wang†()   

  • Received:2020-10-07 Revised:2021-02-15 Published:2021-04-01
  • Corresponding author: Ping Wang
  • Supported by:
    Key Research and Development Project of Science and Technology Department in Sichuan Province(2018FZ0057)
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The Guidelines of the Brazilian Society of Oncologic Surgery for Pelvic Exenteration in the Treatment of Cervical Cancer (hereinafter referred to PE Guidelines) had been published in December 2019 for patients with locally persistent or recurrent cervical cancer (PRCC) after radiotherapy or chemotherapy. Recommendations for the best management of patients with locally PRCC undergoing salvage pelvic exenteration (PE) were developed and based on the best evidence available in literature. This is the first guideline or consensus on PE in the treatment of locally PRCC which has been proposed in the world. The research contents of PE Guidelines include indications for curative and palliative PE, preoperative and intraoperative evaluation, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-ups, which will be interpreted in this article.

Key words: Uterine cervical neoplasms, Persistent or recurrent cervical cancer, Pelvic exenteration, Neoplasm recurrence, local, Postoperative complications, Pelvic floor reconstruction, Reconstructive surgical procedures, Female
表1 《PE指南》证据水平(质量)分级体系
证据水平(质量) 证据来源
Ⅰ 来源于≥1项方法学质量高(偏倚风险低)的针对局部PRCC患者PE的大型随机对照试验，或对进行良好、无异质性的针对局部PRCC患者PE的随机对照试验进行的Meta分析
Ⅱ 来源于针对局部PRCC患者PE的小规模随机对照试验，或方法学质量较低的针对局部PRCC患者PE的大型随机对照试验，或偏倚风险高的Meta分析
Ⅲ 来源于针对局部PRCC患者PE的前瞻性队列研究
Ⅳ 来源于针对局部PRCC患者PE的回顾性队列研究或病例对照研究
Ⅴ 来源于针对局部PRCC患者PE的病例报告和专家观点
表2 《PE指南》推荐级别(强度)分级体系
推荐级别(强度) 证据与强度
A 强烈建议：有力证据证明具有疗效和重大临床益处
B 一般建议：强或中度证据证明具有疗效，但是临床益处有限
C 可选：疗效证据不足，或临床益处不会超过风险或缺点
D 一般不推荐：中度证据证明无效或导致不良结果
E 不推荐：有力证据证明否定疗效或导致不良结果
表3 PE手术范围分类
手术范围 肛提肌以上切除 肛提肌以下切除
前PE 后PE 全PE 前PE 后PE 全PE
子宫/输卵管/卵巢 切除 切除 切除 切除 切除 切除
阴道 部分切除 部分切除 部分切除 切除 切除 切除
外阴 保留 保留 保留 术中评估后决定 保留 术中评估后决定
膀胱、尿道 切除 保留 切除 切除 保留 切除
直肠 保留 切除 切除 保留 切除 切除
肛门括约肌 保留 保留 保留 保留 切除 切除
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