宫颈癌的手术治疗进展

手术治疗是宫颈癌的重要治疗手段。传统的子宫广切术及盆腔淋巴结清扫术已沿用多年,现仍是主要的术式。近年来对宫颈癌的手术强调个性化处理及微创手术。广泛性宫颈切除术使年轻患者保留生育功能成为可能,腹腔镜下宫颈癌的手术也取得很大进展。     

早期宫颈癌广泛性宫颈切除术研究进展

目的:总结国内外关于年轻、早期宫颈癌患者的治疗现状,探讨广泛性宫颈切除术(RT)在早期宫颈癌患者保留生殖生理功能中的应用价值。方法:应用Medline及CNKI全文数据库检索系统,以"早期宫颈癌、广泛性宫颈切除、保留生殖生理功能"等为关键词,检索1994-01-2011-01的相关文献共100篇。纳入标准:1)RT在早期宫颈癌治疗中的应用;2)宫颈粘连狭窄的防治;3)盆底功能重建。根据纳入标准符合分析的文献16篇。结果:RT能达到与广泛性子宫切除术(RH)同样的治疗效果,两者术后并发症与复发率无明显差异,术中应重视宫颈机能不全及子宫脱垂的防治,提高术后生活质量。结论:合理掌握手术指证,对早期宫颈癌实施保留子宫体的治疗是安全的。     

两种不同手术方式治疗早期宫颈癌的手术参数和术后膀胱功能恢复指标的差异

目的 对比两种不同手术方式治疗早期宫颈癌的手术参数和术后膀胱功能恢复指标差异.方法 将124例早期宫颈癌患者分为对照组(行普通腹腔镜下广泛性子宫切除术)和实验组(行腹腔镜下保留盆腔自主神经的广泛性子宫切除术),两组各62例,对比两组手术参数和术后膀胱功能恢复指标的情况.结果 两组相关手术参数对比均无明显差异(P均>0.05);实验组术后导管留置时间、腹压排尿、排尿满意率、膀胱功能障碍、尿失禁与尿潴留发生率均显著优于对照组(P均<0.05).结论 相比普通腹腔镜下广泛性子宫切除术,腹腔镜下保留盆腔自主神经的广泛性子宫切除术更能够改善早期宫颈癌患者的膀胱功能,临床疗效更为理想,临床上值得进一步推广和应用.     

保留盆腔自主神经的广泛性子宫切除术研究进展

早期宫颈癌患者首选手术治疗,其5年生存率可超过80％,但由于手术对盆腔自主神经的损伤,术后往往伴随着严重的盆腔脏器功能障碍。为了改善患者术后生活质量,保留盆腔自主神经的广泛性子宫切除术成为目前的治疗趋势。自1961年以来,保留盆腔自主神经的广泛性子宫切除术历经一系列演变,目前已纳入宫颈癌新的手术分级中。自20世纪90年代以来,腹腔镜逐渐应用于宫颈癌,其放大效应有助于术中对神经的识别,在保留神经手术上具有应用前景。该手术技术在改善术后盆腔脏器功能障碍方面存在一定优势,但该手术安全性的评估尚有待于前瞻性随机对照研究。     

系统保留盆腔自主神经的宫颈癌广泛性子宫切除术对膀胱功能的影响

目的：探讨在宫颈癌患者行广泛性子宫切除术中系统保留盆腔自主神经对膀胱功能的影响。方法：子宫颈癌行广泛性子宫切除术,术中保留盆腔自主神经的宫颈癌患者共38例,取传统广泛性子宫切除术的宫颈癌患者42例作为对照,观察两组患者术后尿动力学变化及膀胱功能恢复时间。结果：保留盆腔自主神经组和传统手术治疗组患者术后10天膀胱无知觉率分别为10.52%和21.43%,差异有统计学意义（P〈0.05）;两组术后10天平均膀胱容量分别为（214.62±45.36）ml和（389.64±49.47）ml,差异有统计学意义（P〈0.05）;两组术后膀胱功能恢复正常时间分别为（11.64±2.01）天和（18.64±3.26）天,差异有统计学意义（P〈0.05）。结论：广泛性子宫切除术发生膀胱功能障碍,主要是盆腔自主神经的损伤;术中系统保留盆腔自主神经可缩短术后尿潴留时间,有利于术后膀胱功能的恢复。     

系统保留盆腔自主神经的宫颈癌广泛性子宫切除术对膀胱功能的影响

目的:探讨在宫颈癌患者行广泛性子宫切除术中系统保留盆腔自主神经对膀胱功能的影响.方法:子宫颈癌行广泛性子宫切除术,术中保留盆腔自主神经的宫颈癌患者共38例,取传统广泛性子宫切除术的宫颈癌患者42例作为对照,观察两组患者术后尿动力学变化及膀胱功能恢复时间.结果:保留盆腔自主神经组和传统手术治疗组患者术后10天膀胱无知觉率分别为 10.52%和21.43%,差异有统计学意义(P<0.05);两组术后10天平均膀胱容量分别为(214.62±45.36)ml和(389.64±49.47)ml,差异有统计学意义(P<0.05);两组术后膀胱功能恢复正常时间分别为(11.64±2.01)天和(18.64±3.26)天,差异有统计学意义(P<0.05).结论:广泛性子宫切除术发生膀胱功能障碍,主要是盆腔自主神经的损伤;术中系统保留盆腔自主神经可缩短术后尿潴留时间,有利于术后膀胱功能的恢复.     

乙状结肠阴道延长术在子宫颈癌行广泛性全子宫切除术中的应用

目的 改善和提高子宫颈癌患者施行广泛性全子宫切除术后的生活质量.方法 15例子宫颈癌施行广泛性全子宫切除术同时行乙状结肠阴道延长术、并保留一侧卵巢,观察对患者术后生活质量的影响,探讨该术式的临床应用价值.结果 全部病例术后卵巢功能基本正常,性生活质量无明显影响.结论 保留一侧卵巢并同时施行乙状结肠阴道延长术的广泛性全子宫切除术是一个值得推广应用的术式.     

腹腔镜下保留神经宫颈癌根治术的近期疗效

目的:探讨腹腔镜下保留神经的广泛性子宫切除术(SNSRH)治疗早期宫颈癌的近期疗效.方法:选取我院从2015年12月至2016年12月收治的100例早期富颈癌患者,按照随机对照原则分为腹腔镜下保留神经的广泛性子宫切除术(SNSRH组)和腹腔镜下广泛性子宫切除术(LRH组),分析术后近期疗效.结果:两组患者手术均顺利进行,两组患者的手术时间、淋巴结清扫数目、术中出血量比较,差异无统计学意义(P＞0.05);SNSRH组患者术后排气时间、术后排便时间、拔出尿管时间、膀胱功能恢复时间、术后住院时间较LRH组患者明显缩短,差异具有统计学意义(P＜0.05);两组患者术后膀胱功能障碍比较:LRH组患者术后伴有更明显的间断排尿、腹压排尿、尿失禁、尿潴留症状(P＜0.05);对于尿频症状,无统计学差异(P＞0.05).结论:腹腔镜下保留神经的宫颈癌根治术的近期临床疗效好,值得在临床上应用和推广.     

术前预防性应用抗生素降低宫颈癌术后感染的临床观察

术前预防性应用抗生素降低宫颈癌术后感染的临床观察孟跃进，鲍耀君，黄飞飞术后感染是广泛性子宫切除术后最为常见的合并症之一。为了探讨术前预防性应用抗生素对降低广泛性子宫切除术后感染的临床价值，对我院施行手术治疗的１１０例宫颈癌病例分析总结如下：临床资料与...     

宫颈癌腹腔镜下保留盆腔自主神经的广泛子宫切除术

宫颈癌是女性生殖系统最常见的恶性肿瘤,其发病呈年轻化趋势且早期患者5年生存率几乎达90%。因此,减少并发症,提高生活质量已成为宫颈癌术后患者关注的重点。近些年,微创观念的提出及腹腔镜技术的发展,腹腔镜下保留盆腔自主神经的广泛性子宫切除术逐渐成为目前早期宫颈癌临床研究的热点。     

Treatment of stage IB2 (bulky) cervical carcinoma

Tumour size is an important prognostic factor in patients with stage IB cervical cancer. The patient with stage IB2 (bulky) cervical cancer represents a therapeutic challenge. Neither radical hysterectomy nor primary radiation therapy are sufficiently effective and are associated with significant treatment-related complications including ovarian failure and psychosexual deficits. A number of phase III studies have explored alternative management approaches in this patient population. It appears that extrafascial hysterectomy following radiation therapy does not improve overall survival relative to radiation therapy alone. Consistent with results seen in locally advanced cervical carcinoma, chemoradiation therapy is superior to radiation therapy alone as primary treatment for stage IB2 cervical cancer and as adjuvant therapy for surgically treated patients with high-risk factors for recurrence. Neoadjuvant chemotherapy has resulted in high clinical response rates and operability rates. There are two phase III trials suggesting an improvement in survival with neoadjuvant chemotherapy followed by radical hysterectomy versus either surgery (and selected postoperative radiation) or radiation therapy alone. These emerging treatments should be scrutinized in prospective controlled trials.     

Preoperative arterial interventional chemotherapy on cervical cancer

Objective： To discuss the therapeutic effect of preoperative interventional chemotherapy on cervical cancer. Methods： Preoperative interventional chemotherapy by femoral intubation was performed in 25 patients with bulky cervical cancer. The patients received bleomycin 45 mg and cisplatin or oxaliplatin 80 mg/m^2. Results： 25 cases （including 8 cases with stage I and 17 cases with stage II） received one or two courses of preoperative interventional chemotherapy. The size of the focal lesions was decreased greatly and radical hysterectomy and lymphadenectomy were performed successfully in all the patients. All of the specimens were sent for pathological examination. Lymphocyte infiltration was found more obvious in the cancer tissues as compared with their counterpart before treatment. As a result, relevant vaginal bleeding was stopped completely shortly after the treatment. Conclusion： Arterial interventional chemotherapy was proved to reduce the local size of cervical cancer and thus control the hemorrhage efficiently. The patients with cervical cancer can receive radical hysterectomy therapy after the interventional chemotherapy.     

Current approaches of neoadjuvant chemotherapy in cervical cancer

Despite remarkable improvement in clinical management, the survival of cervical cancer patients has shown only minor progress in the last decade, particularly in patients with advanced and high-risk disease. Multimodal treatment option has been investigated, such as the concurrent use of chemotherapy and radiation, neoadjuvant chemotherapy and radical hysterectomy, or neoadjuvant chemotherapy followed by radiotherapy. Recently, a flow of randomized clinical trials have demonstrated a benefit from the concurrent chemoradiation for the treatment of the cancer of the cervix. This review will summarize the role and benefit of neoadjuvant chemotherapy in combination with sequential or concurrent radiotherapy and radical surgery for treatment of cervical cancer.     

New developments in the treatment of cervical cancer

Cervical cancer is world-wide the second most frequent cancer found in women and represents 12% of all female malignancies. In fact, it is the most common female cancer in developing countries. There is now sufficient evidence to recommend that women with locally advanced cervical cancer confined to the pelvis receive concurrent pelvic radiation and chemotherapy. New surgical techniques such as laparoscopically assisted radical vaginal hysterectomy and trachelectomy (a fertility-preserving radical operation technique) are being established and have to be evaluated for their long-term safety. Causal treatment by developing multivalent antiviral drugs and vaccines is no longer a pure theoretical approach. Despite these improvements, the early diagnosis by colposcopy and gynaecological cytology remains the safest method to ensure early treatment avoiding death of cervical cancer.     

子宫动脉化疗栓塞与髂内动脉灌注化疗在局部晚期宫颈癌综合治疗中的疗效对比

背景与目的：子宫动脉化疗栓塞与髂内动脉灌注化疗是临床治疗宫颈癌的重要方法．两者疗效有无差异尚无定论。本研究比较子宫动脉化疗栓塞和髂内动脉灌注化疗在局部晚期宫颈癌综合治疗中的疗效。方法：将1997年4月至2007年11月间收治的175例局部晚期宫颈癌患者分为两组。子宫动脉化疗栓塞组92例,双侧子宫动脉插管注药后行双侧子宫动脉栓塞,65例行子宫颈癌根治术,其中37例术前采用^192Ir高剂量率腔内后装放疗。髂内动脉灌注化疗组83例,采用双侧髂内动脉插管注药,70例行子宫颈癌根治术,其中34例术前采用同样的腔内后装放疗。两组化疗方案均为以铂类为主的联合方案。根据术后病理结果,对51例有病理危险因素的患者加用外放射治疗。结果：子宫动脉化疗栓塞组总有效率为64．1％,明显高于髂内动脉灌注化疗组（47．0％,P=0．023）。子宫动脉化疗栓塞组IB期患者的肿瘤缩小有效率（77．8％）明显高于髂内动脉灌注化疗组（41．2％,P=0．037）,两组Ⅱ、Ⅲ期患者的总有效率差异无统计学意义（P=0．137和P=0．524）。术后病理结果显示,子宫动脉化疗栓塞组癌细胞阴性率、盆腔淋巴结转移阴性率、无复发率均略高于髂内动脉灌注化疗组,但差异无统计学意义（P〉0．05）;而脉管癌栓阴性率略低于髂内动脉灌注化疗组（P=0．072）。子宫动脉化疗栓塞组1、3、5年总生存率与髂内动脉灌注化疗组相比差异无统计学意义（P=0．665）。结论：子宫动脉化疗栓塞联合术前放疗可有效缩小局部晚期宫颈癌的肿瘤体积,但不能增加病理完全缓解率、不能减少淋巴结转移和术后复发,控制脉管癌栓略差于髂内动脉灌注化疗,对远期生存率尚未显示出优势,有待进一步长期随访。     

Asian society of gynecologic oncology workshop 2010

This workshop was held on July 31-August 1, 2010 and was organized to promote the academic environment and to enhance the communication among Asian countries prior to the 2nd biennial meeting of Australian Society of Gynaecologic Oncologists (ASGO), which will be held on November 3-5, 2011. We summarized the whole contents presented at the workshop. Regarding cervical cancer screening in Asia, particularly in low resource settings, and an update on human papillomavirus (HPV) vaccination was described for prevention and radical surgery overview, fertility sparing and less radical surgery, nerve sparing radical surgery and primary chemoradiotherapy in locally advanced cervical cancer, were discussed for management. As to surgical techniques, nerve sparing radical hysterectomy, optimal staging in early ovarian cancer, laparoscopic radical hysterectomy, one-port surgery and robotic surgery were introduced. After three topics of endometrial cancer, laparoscopic surgery versus open surgery, role of lymphadenectomy and fertility sparing treatment, there was a special additional time for clinical trials in Asia. Finally, chemotherapy including neo-adjuvant chemotherapy, optimal surgical management, and the basis of targeted therapy in ovarian cancer were presented.     

Management of cervical cancer.

AIMS: The aim of the article was to review the current approach to management of cervical cancer. METHODS: The relevant literature has served as a source for review of different options applied in the management of cervical cancer. RESULTS: Treatment of invasive cervical cancer is affected by the stage of the disease, which is based on clinical evaluation. Microinvasive carcinoma of the cervix has limited metastatic potential and therefore is most likely curable by non-radical treatment. There is no standard management of stage Ib-IIa cervical carcinoma. Both radical surgery and radical radiotherapy have proven to be equally effective, but differ in associated morbidity and complications. Most often, stage Ib1 cervical cancer is treated by radical hysterectomy with pelvic lymphadenectomy. Laparoscopically assisted radical vaginal hysterectomy has shown similar efficacy and recurrence rates. Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy may be an option in small cervical cancer where preservation of fertility is desired. There is lot of conflicting published work regarding the treatment of bulky stage Ib-IIa cervical cancer. While some centers are performing primary surgery as for Ib1 disease followed by tailored postoperative radiation with or without chemotherapy, the others are in favor of primary chemo-radiation therapy. Neoadjuvant chemotherapy followed by radical surgery has emerged as a possible alternative, which may improve a survival in patients with stage Ib2 disease. Concomitant chemoradiation is becoming a new standard in treatment of advanced disease, because it has been clearly shown to improve disease-free, progression-free and overall survival. Management of recurrent disease depends on previous treatment, site and extent of recurrence, disease-free interval and patient's performance status. CONCLUSIONS: Treatment decisions should be individualized and based on multiple factors including the stage of the disease, age, medical condition of the patient, tumor-related factors and treatment preferences, to yield the best cure with minimum complications.     

Neoadjuvant chemotherapy followed by cesarean radical hysterectomy in a triplet pregnancy complicated by clear cell carcinoma of the cervix: a case presentation and literature review

OBJECTIVE: To report a triplet pregnancy complicated by clear cell cervical carcinoma that was managed using neoadjuvant chemotherapy followed by caesarean radical hysterectomy. PATIENT HISTORY: A 26-year-old woman had a diagnosis of cervical clear cell carcinoma, which was International Federation of Gynecology and Obstetrics stage IB1, at 18 weeks of gestation during a triplet pregnancy. Owing to the patient's strong desire for full-term pregnancy, 3 cycles of neoadjuvant chemotherapy was administered after magnetic resonance imaging evaluation of the tumor. The patient underwent cesarean delivery and radical hysterectomy at gestational week 32. The hysterectomy specimen revealed stage IB1 clear cell adenocarcinoma of the cervix. The neonates and the mother did not have any complications related to the treatment during 36 months of follow-up. CONCLUSION: To the best of our knowledge, this is the first report of a triplet pregnancy complicated by cervical clear cell carcinoma that was successfully treated with neoadjuvant chemotherapy and cesarean radical hysterectomy. Our experience and literature review suggest that neoadjuvant chemotherapy for cervical carcinoma diagnosed during pregnancy is associated with excellent oncologic and fetal outcome; therefore, it may be considered as a temporary fertility-sparing approach in selected patients with a strong desire for full-term pregnancy. Nonetheless, additional research and long-term follow-up are needed to reach a more definitive conclusion.     

Neoadjuvant chemotherapy and concurrent chemoradiation in the treatment of advanced cervical cancer

The role of chemotherapy in the management of advanced cervical cancer has been long debated. Whereas some phase II trials have shown promising results with neoadjuvant chemotherapy followed by irradiation, most phase III trials failed to demonstrate any benefit with this sequential treatment in terms of loco-regional control and survival, mainly because chemotherapy could cause accelerated tumor clonogen resistant cell repopulation The data on cisplatin-based neoadjuvant chemotherapy before surgery appear to be more promising. This treatment modality can increase the operability rate and reduce the incidence of positive nodes and other pathological risk factors. However, very few randomized trials comparing cisplatin-based neoadjuvant chemotherapy followed by radical hysterectomy versus conventional irradiation treatment are currently available, whilst data about long-term survival of chemo-surgical-treated patients are scanty. Recently five prospective randomized trials compared concurrent cisplatin-based chemotherapy and irradiation versus hydroxyurea plus irradiation or irradiation alone. All showed a significant improvement in the outcome of patients treated with concurrent cisplatin-based chemoradiation. Based on these data, the National Cancer Institute released a Clinical Announcement stating that concurrent cisplatin-based chemoradiation should be the new standard of therapy for high-risk early stage and locally advanced cervical cancer. The introduction of taxanes in both neoadjuvant chemotherapy followed by radical hysterectomy and concurrent chemoradiation could further improve the results of these two treatment modalities. A multicenter randomized trial comparing chemo-surgical treatment with concurrent chemoradiation is warranted to better define the optimum therapeutic strategy for patients with advanced cervical cancer.     

Clusterin Expression Inversely Correlates with Chemosensitivity and Predicts Poor Survival in Patients with Locally Advanced Cervical Cancer Treated with Cisplatin-Based Neoadjuvant Chemotherapy and Radical Hysterectomy

Overexpression of clusterin, an antiapoptotic molecule, has been reported to induce resistance to chemotherapy in a variety of cancer cell types. The aim of this study was to evaluate the significance of clusterin expression to predict response to platinum-based neoadjuvant chemotherapy and survival of patients with invasive cervical cancer who subsequently underwent radical hysterectomy. Biopsy specimens of invasive cervical cancer before neoadjuvant chemotherapy were obtained from 46 patients who subsequently underwent radical hysterectomy at Hokkaido University Hospital and Gunma University Hospital from 1994 to 2007. The expression of clusterin protein was analyzed by immunohistochemistry. Findings were evaluated in relation to several clinicopathological factors. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Clusterin protein was mainly present in the cytoplasm of cervical cancer cells. The expression of clusterin protein in cervical cancer tissues before neoadjuvant chemotherapy was significantly related to poor response to chemotherapy among factors analyzed. Univariate analysis on prognostic factors showed that response to chemotherapy (p = 0.01), lymph node metastasis (p = 0.02), and clusterin expression (p = 0.02) were related to survival. Multivariate analysis revealed that lymph node metastasis (p = 0.03), and clusterin expression (p = 0.03) were independent prognostic factors for survival of cervical cancer patients. We conclude that clusterin expression could be a new molecular marker to predict response to platinum-based chemotherapy and survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.