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ENGLISH ABSTRACT
腹腔镜与开腹行子宫广泛性切除术治疗Ⅰa2~Ⅱb期子宫颈癌安全性及有效性的比较
杨露
杨萍
李东林
蔡晶
沈怡
董卫红
张媛
熊宙芳
陈辉
闵洁
汪宏波
王英红
梁文通
王泽华
作者及单位信息
·
DOI： 10.3760/cma.j.issn.0529-567X.2015.12.007
Comparison of safety and efficacy of laparoscopic versus abdominal radical hysterectomy in the treatment of patients with stage Ⅰ a2- Ⅱ b cervical cancer
Yang Lu
Yang Ping
Li Donglin
Cai Jing
Shen Yi
Dong Weihong
Zhang Yuan
Xiong Zhoufang
Chen Hui
Min Jie
Wang Hongbo
Wang Yinghong
Liang Wentong
Wang Zehua
Authors Info & Affiliations
Yang Lu
Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Yang Ping
Department of Obstetrics and Gynecology, First Affiliated Hospital，School of Medicine, Shihezi University, Shihezi 832008, China
Li Donglin
Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang 550002, China
Cai Jing
Shen Yi
Dong Weihong
Zhang Yuan
Xiong Zhoufang
Chen Hui
Min Jie
Wang Hongbo
Wang Yinghong
Liang Wentong
Wang Zehua
·
DOI： 10.3760/cma.j.issn.0529-567X.2015.12.007
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摘要

目的比较腹腔镜与开腹行子宫广泛性切除术治疗Ⅰa2～Ⅱb期子宫颈癌的安全性及有效性。

方法收集2000年至2015年华中科技大学同济医学院附属协和医院、石河子大学医学院第一附属医院及贵州省人民医院收治的确诊为Ⅰa2～Ⅱb期子宫颈癌的1 529例患者的临床病理资料并进行回顾性分析。其中，1 052例患者接受腹腔镜下行子宫广泛性切除术（LRH）+盆腔淋巴清扫术（腹腔镜组），477例接受开腹行子宫广泛性切除术（ARH）+盆腔淋巴清扫术（开腹组）。比较两组患者的手术相关指标、术中和术后并发症、预后的差异。

结果（1）临床病理指标：腹腔镜组、开腹组患者的临床分期、病理类型、淋巴结转移、宫旁浸润、新辅助化疗分别比较，差异均有统计学意义（ P< 0.05）。因资料不均衡，进一步按临床分期进行分层，分为Ⅰa2～Ⅰb1期861例，包括663例腹腔镜组、198例开腹组；Ⅰb2～Ⅱb期668例，包括389例腹腔镜组、279例开腹组。按临床分期分层后，分别在Ⅰa2～Ⅰb1期和Ⅰb2～Ⅱb期子宫颈癌中，两组患者的年龄、病理类型、病理分化程度、宫旁浸润、淋巴脉管间隙受累（LVSI）及新辅助化疗分别比较，差异均无统计学意义（ P>0.05）。（2）手术相关指标：按临床分期分层后，分别在Ⅰa2～Ⅰb1期和Ⅰb2～Ⅱb期患者中，腹腔镜组手术时间（中位数均为240 min）明显长于开腹组（中位数均为220 min； P=0.027， P=0.000），术中出血量（中位数分别为200、300 ml）显著少于开腹组（中位数均为500 ml； P值均为0.000），术中输血率（分别为14.3%、22.6%）显著低于开腹组（分别为53.5%、48.4%； P值均为0.000）。（3）术中、术后并发症：按临床分期分层后，分别在Ⅰa2～Ⅰb1期和Ⅰb2～Ⅱb期中，腹腔镜组与开腹组术中并发症、术后并发症（除外尿潴留）及尿潴留的发生率比较，差异均无统计学意义（ P>0.05）。（4）复发和生存情况：中位随访时间为24个月（1~ 177个月），随访期内腹腔镜组、开腹组患者的复发率分别为3.6%（38/1 052）、3.1%（15/477），两组比较，差异无统计学意义（ P>0.05）。腹腔镜组、开腹组的3年总生存率分别为92.4％和91.8%，3年无瘤生存率均为91.5%，两组分别比较，差异均无统计学意义（ P=0.738， P=0.990）。按临床分期分层后，分别在Ⅰa2～Ⅰb1期和Ⅰb2～Ⅱb期子宫颈癌患者中，腹腔镜组和开腹组的3年总生存率及3年无瘤生存率分别比较，差异均无统计学意义（ P>0.05）。

结论LRH+盆腔淋巴清扫术治疗Ⅰa2～Ⅱb期子宫颈癌是安全、有效的，可以作为常规治疗手段之一。

宫颈肿瘤;子宫切除术;腹腔镜检查
ABSTRACT

ObjectiveTo compare the safety and efficacy after laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in the treatment of patients with stage Ⅰa2-Ⅱb cervical cancer.

MethodsIn a retrospective study, data were analyzed from patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰa2- Ⅱ b cervical cancer underwent LRH or ARH at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; First Affiliated Hospital, School of Medicine, Shihezi University; and the Guizhou Provincial People's Hospital between 2000 and 2015. Perioperative outcomes and survival analysis were compared.

Results(1) The FIGO stages, histotypes, metastasis of lymph nodes, lymph vascular space invasion and neoadjuvant chemotherapy significantly differed between the LRH group and the ARH group (all P<0.05). In order to eliminate the effects by the unbalanced data, stratified analysis was conducted based on FIGO stage. There were 861 patients in stage Ⅰa2-Ⅰb1 group, including 663 patients in LRH group and 198 patients in ARH group. And there were 668 patients in stageⅠb2-Ⅱb group, including 389 patients in LRH group and 279 patients in ARH group. (2) In the patients with stage Ⅰ a2- Ⅰ b1 and Ⅰ b2- Ⅱ b tumor, there were no significant difference in age, histotype, differentiation degree, parametrial invasion, lymphvasular invasion space and neoadjvant chemotherapy between the LRH group and the ARH group (all P>0.05). For patients with stageⅠa2- Ⅰb1, the operation time in the LRH group was longer than that in the ARH group ( P=0.027), and it showed less blood loss and lower blood transfusion rate in the LRH group than those in the ARH group (all P=0.000). The findings were similar in the patients with stage Ⅰb2-Ⅱb (all P=0.000). (3) There were no significant difference in intraoperative complications and postoperative complications between the LRH and the ARH group in the patients with stageⅠa2-Ⅰb1 and Ⅰb2-Ⅱb, respectively (all P>0.05). (4) The median follow- up time was 24 months (range: 1 to 177 months), the recurrence rate was 3.6% (38/1 052) in LRH group and 3.1% (15/477) in ARH group,there was not significant difference ( P>0.05). The estimated 3- year overall survival (OS) and the free-progression survival time (PFS) were respectively 92.4% and 91.5% in LRH group, and 91.8% and 91.5% in ARH group. There was no significant difference in the overall survival ( P=0.738) or progress free survival ( P=0.990) by log-rank test. Moreover, there were no significant difference in OS or PFS between the LRH group and the ARH group in patients with stage Ⅰ a2- Ⅰ b1 and Ⅰ b2- Ⅱ b, respectively (all P>0.05).

ConclusionLRH is safe and effective, and it could be used a routine way for the treatment of patients with stageⅠa2-Ⅱb cervical cancer.

Uterine cervical neoplasms;Hysterectomy;Laparoscopy
Wang Zehua, Email: tendef.3ab61gnawauhez

Yang Lu, Yang Ping and Li Donglin contributed equally to the article

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引用本文

杨露,杨萍,李东林,等. 腹腔镜与开腹行子宫广泛性切除术治疗Ⅰa2~Ⅱb期子宫颈癌安全性及有效性的比较[J]. 中华妇产科杂志,2015,50(12)：915-922.

DOI:10.3760/cma.j.issn.0529-567X.2015.12.007

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开腹行子宫广泛性切除术（abdominal radical hysterectomy，ARH）＋盆腔淋巴清扫术是治疗子宫颈癌的标准术式。而自1992年Nezhat等 [ 1 ]首次报道腹腔镜下行子宫广泛性切除术（laparoscopic radical hysterectomy，LRH）＋盆腔淋巴清扫术治疗子宫颈癌以来，该手术方式开始被临床应用。近年来，有多项对LRH＋盆腔淋巴清扫术与ARH＋盆腔淋巴清扫术治疗早期子宫颈癌进行对比的研究，结果证实，腹腔镜手术的治疗效果及并发症与开腹手术相当 [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]，且可减少术中出血量、缩短住院时间、提高患者术后近期生命质量 [ 16 ]。LRH存在手术时间长和是否能达到根治性手术的标准等问题 [ 17 , 18 ]；本研究进行了大样本量多中心的回顾性分析以及长期随访，旨在对比LRH＋盆腔淋巴清扫术与ARH＋盆腔淋巴清扫术治疗Ⅰa2～Ⅱb期子宫颈癌患者的临床病理资料、手术并发症及预后，探讨腹腔镜手术在子宫颈癌治疗中的安全性和有效性，以指导临床实践。
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王泽华，Email： tendef.3ab61gnawauhez
B

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