腹腔镜下保留生育功能宫颈根治术治疗早期宫颈癌的临床疗效分析.docVIP

腹腔镜下保留生育功能宫颈根治术治疗早期宫颈癌的临床疗效分析 　　【摘要】 目的：探讨有生育要求的早期宫颈癌患者在腹腔镜下行广泛宫颈切除和盆腔淋巴结清扫术的临床效果。方法：选取2008年3月-2014年1月本院10例要求保留生育功能的早期宫颈癌患者为研究对象，收集临床资料及随访结果，进行分析。结果：10例中宫颈鳞癌9例，宫颈腺癌1例；临床分期（FIGO，2009）：ⅠA2期1例，ⅠB1期9例；3例行腹腔镜下盆腔淋巴结清扫和广泛宫颈切除（LRT），7例行腹腔镜下盆腔淋巴结清扫和阴式广泛宫颈切除术（LVRT）；1例术前行新辅助化疗（NACT）3个疗程，1例术后进行2个疗程的化疗。术后中位随访时间21个月，妊娠2例，其中1例于孕36周剖宫产，1例试管婴儿现妊娠13周，复发1例。结论：对于有生育要求的早期宫颈癌患者，腹腔镜下行广泛宫颈切除和盆腔淋巴结清扫术是安全可行的。 　　【关键词】 早期宫颈癌； 保留生育功能； 广泛宫颈切除； 腹腔镜 　　【Abstract】 Objective：To explore the clinical efficacy of laparoscopic radical trachelectomy and lymphadenectomy in the treatment of early-stage cervical cancer.Method：Patients who had undergone the fertility-sparing treatments in our hospital from 2008 to January 2014 were recruited in this study. The clinical and follow-up records were analyzed.Result：Among the 10 patients，there were 9 cases of squamous cell carcinoma，1 case of and enocarcinoma. 1 case with stage IA1，9 cases with stage IB1（FIGO，2009）. 3 patients underwent laparoscopic lymphadenectomy and radical trachelectomy，7 patients underwent laparoscopic lymphadenectomy and vaginal radical trachelectomy，1 case received neoadjuvant chemotherapy of 3 courses，1 case received chemotherapy of 2 courses after surgery.All patients under follow-up with the median follow-up time 21 months，2 pregnancies occurred. Among them，1patient had full-term，1 patient was 13 weeks of pregnancy by in vitro fertilization-embryo transfer.1 patient relapsed after the fertility-sparing treatment.Conclusion：Laparoscopic radical trachelectomy and lymphadenectomy is a safe and effective fertility-sparing treatment for young women with early-stage cervical cancer. 　　【Key words】 Early-stage cervical cancer； Fertility-sparing； Radical trachelectomy； Laparoscope 　　First-author’s address：The First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China 　　doi：10.3969/j.issn.1674-4985.2015.09.041 　　宫颈癌是全世界妇女的第二大最常见恶性肿瘤，发病率居妇科恶性肿瘤首位。随着高危HPV检测、液基细胞学筛查及阴道镜的应用，早期宫颈癌的诊断率明显提高，且呈现年轻化趋势。随着有生育要求的早期宫颈癌患者增加，广泛宫颈切除术被认为是近年