改良腹式广泛宫颈切除术(MART)在早期宫颈癌保留生育功能治疗中的应用分析

目的 探讨改良腹式宫颈广泛切除术治疗有生育要求的早期宫颈癌的疗效及安全性.方法 选择早期宫颈癌患者42例,按照不同手术方式分为改良腹式广泛宫颈切除术(改良组)31例和开腹广泛宫颈切除术(对照组)11例.记录2组患者手术时间、术中出血量、切除淋巴结数目、保留宫颈长度、切除宫旁组织长度,术后引流量、并发症、住院时间、膀胱功能恢复情况及术后病理情况.随访患者宫颈创面愈合情况,月经恢复情况、复发情况及受孕情况.结果 改良组患者手术时间、术中出血量、子宫动脉损伤率、子宫切除率明显小于对照组,差异有统计学意义(P＜0.05);2组患者切除淋巴结个数与切除宫旁组织长度差异无统计学意义(P＞0.05).改良组患者住院时间、膀胱功能障碍发生率和宫颈黏连发生率显著小于对照组,差异有统计学意义(P＜0.05).2组患者术后均未出现复发,改良组患者术后月经减少发生概率为12.9％,显著低于对照组的27.3％ (P ＜0.05).结论 改良腹式宫颈广泛切除术治疗有生育要求的早期宫颈癌患者疗效确切,安全性高,是一种值得临床推广的早期宫颈癌治疗术式.

Analysis of the Application of Modified Abdominal Hysterectomy in the Treatment of Early Stage Cervical Cancer

Objective To investigate the efficacy and safety of modified abdominal cervical extensive resection in the treatment of early cervical cancer patients with fertility requirements.Methods Selected 42 patients with early stage of cervical cancer.According to different surgical methods,they were divided into modified abdominal hysterectomy widely (improvement group) 31 cases and abdominal radical trachelectomy (control group) 11 cases.Recorded operation time,intraoperative bleeding volume,resection of lymph node number,keep cervical length,length of cervical fat tissue resection,postoperative drainage volume,complications,hospitalization time,bladder function recovery after operation and pathology of the 2 groups.Followed up cervical wound healing,menstruation recovery,recurrence and pregnancy of the 2 groups.Results The operation time,the amount of bleeding,the rate of uterine artery injury and hysterectomy rate of the modified group were significantly less than that of the control group,the difference was statistically significant (P ＜ 0.05).There was no significant difference in the number of lymph nodes resected between the 2 groups (P ＞ 0.05).The incidence of hospitalization time,bladder dysfunction and incidence of cervical adhesions were significantly less than that of the control group,the difference was statistically significant (P ＜ 0.05).No recurrence occurred in the 2 groups,and the incidence of postoperative menstrual cycle was 12.9％,which was significantly less than 27.3％ (P ＜ 0.05) in the control group.Conclusion The improvement of abdominal hysterectomy in the treatment of early cervical cancer patients with fertility requirements is accurate with high safety,it is worthy of clinical promotion.