子宫颈癌手术并发症的防治

经典的子宫颈癌根治术尽管是风险大、技术要求高、容易出现各种并发症的手术,但同时又是一个解剖性、规范性手术.因此,应该通过规范化的手术操作,避免术中血管、神经及器官损伤的发生.     

腹腔镜手术用于子宫颈癌治疗的进展

近年腹腔镜广泛子宫切除术越来越多的用于宫颈癌的治疗,其安全性及可行性得到肯定。腹腔镜宫颈癌根治术在切除淋巴结数量、术中出血量、术中并发症发生率、术后复发率及死亡率方面与传统经腹手术无明显差异。但手术时间长于经腹手术。术中并发症主要有血管损伤、膀胱及肠道损伤。     

腹腔镜阴式广泛性子宫颈切除术治疗早期子宫颈癌的临床分析

目的探讨腹腔镜阴式广泛性子宫颈切除术（LVRT）治疗早期宫颈癌的临床效果、手术指征和高危患者的处理原则.方法回顾性分析2003年12月至2005年11月2年间,16例早期宫颈癌患者进行LVRT的临床资料.结果 16例患者平均年龄为29岁（26～34岁）,11例未生育,4例已有子女,但所有患者均要求保留生育功能.国际妇产科联盟（FIGO）分期为2例Ⅰa2期,13例Ⅰb1期和1例Ⅰb2期;15例鳞癌,1例腺鳞癌.手术的平均时间3.20 h,平均出血量320 ml.16例患者中无泌尿道、肠道损伤和术中大出血等严重并发症发生.平均随诊时间13个月,1例复发,复发率为6%.无患者在治疗后的随诊期内妊娠.结论对早期宫颈癌患者施行以LVRT为主的保留生育功能的治疗是可行的.     

子宫颈癌患者手术质量管理分析

目的 探讨中山大学孙逸仙纪念医院子宫颈癌手术质量管理水平,评估优缺点,促进实施规范手术质量管理计划.方法 借鉴《欧洲妇科肿瘤学会子宫颈癌手术治疗质量指标(2020版)》,对中山大学孙逸仙纪念医院妇科肿瘤专科2016年1月1日至2018年12月31日收治的子宫颈癌手术病例进行手术质控评估分析.结果 所有手术均由具有四级手...     

从并发症角度看子宫颈癌腹腔镜手术与开腹手术之争

        2018年Ramirez等［1］发表在《新英格兰医学杂志》上的LACC（laparoscopic approach to cervical cancer）前瞻性临床试验结果显示,子宫颈癌微创手术（84.4%为腹腔镜手术）的无病生存率及总生存率较开腹手术低。此文章颠覆了国内外妇瘤医生对于子宫颈癌中运用腹腔镜技术的肿瘤学安全性的认知［2-3］,因而2019年美国国家综合癌症网络（NCCN）指南［4］推荐,在患者行腹腔镜或其他微创手术前,需明确告知腹腔镜手术会导致较差的远期肿瘤学预后。 浏览更多请关注本刊微信公众号及当期杂志。     

子宫颈癌术前辅助治疗的规范化

新辅助化疗(neoadjuvant chemotherapy,NACT)是子宫颈.癌术前或放疗前辅助治疗的主要方式,原则上适用于局部晚期(Ⅰ B3～ⅣA期)和部分特殊类型的子宫颈癌患者.顺铂为首选药物,推荐化疗2～3个疗程.肿瘤直径大于4cm的Ⅰ B3～ⅡA2期的子宫颈鳞癌和腺癌的部分患者可以采用新辅助化疗+根治性手术...     

子宫颈癌手术治疗质量控制标准中国专家共识之QM-C1型广泛性子宫切除篇#br#

广泛性子宫切除术（radical hysterectomy,RH）历经100多年的历史证明了其在早期子宫颈癌治疗中具有确切的疗效,与其他所有手术术式的演变过程一样,经历了漫长的从简单到复杂、从粗犷到精细的不断改良过程,具体表现在切除范围和术式的演变,实际上这种转变同样也体现了术者对肿瘤属性的认识过程。     

子宫颈癌手术治疗质量控制标准中国专家共识之QM-C2型广泛性子宫切除篇北大核心CSCD

手术是早期子宫颈癌的主要治疗方式,根据国际指南,开腹广泛性子宫切除术+盆腔淋巴结切除术±腹主动脉旁淋巴结切除术是子宫颈癌手术的标准术式^([1-3])。中国子宫颈癌临床诊疗大数据项目数据库研究显示^([4]),数据库内47家医疗机构2004—2018年连续住院的63926例各期子宫颈癌患者中,接受手术治疗者为48727例,非手术病例15199例;其中早期子宫颈癌接受手术治疗的比例更高。     

子宫颈癌手术治疗质量控制标准中国专家共识之QM-A型/QM-B1型广泛性子宫切除篇

<正>经过百余年的临床实践,子宫颈癌手术治疗从起源到形成标准术式[1],逐步定格为广泛性子宫切除术（radicalhysterectomy,RH）+盆腔淋巴结切除术（pelvic lymphadenec-tomy,PLN）[2]。RH手术的术式分型几经变化,自2008年发布的RH术式QM分型[3]被国际妇产科联盟（FIGO）、美国国立综合癌症网络（NCCN）等国际组织指南采用,我们所熟悉并且应用三十余年的PIVER分型不再被推荐使用[4]。     

输卵管妊娠手术质量控制北大核心CSCD

输卵管妊娠手术是妇科领域较为基础的手术,二级医疗机构及具备主治医师职称医生即有开展资质,受术者多为年轻、有生育要求女性。建立输卵管妊娠手术质量控制体系,从手术适应证掌握、手术途径和手术方式的选择、术后病理学诊断及术后随访等环节强化输卵管妊娠手术质量控制标准,规范手术技术,有助于提高我国输卵管妊娠的手术治疗水平。     

保留盆腔神经的广泛性子宫切除术治疗宫颈癌疗效及安全性荟萃分析

目的 评价保留盆腔自主神经的广泛性子宫切除术(nerve-sparing radical hysterectomy,NSRH)治疗宫颈癌的临床疗效和安全性。方法 检索大型数据库中近11年发表的关于NSRH与传统广泛性子宫切除术(radical hysterectomy,RH)临床疗效比较的前瞻性同期对照试验。并按Cochrane系统评价方法提取有效数据进行Meta分析。结果 NSRH与RH相比,其术后留置尿管时间[加权均数差（weighted mean difference,WMD）=－6.73,95%可信区间（CI）－7.39~－6.06]、残余尿量<50 mL时间(WMD=－7.80,95%CI－11.93~－3.67)、首次排气时间(WMD =－12.05,95%CI －15.87~－8.24)、首次排便时间(WMD =－24.99,95%CI －26.87 ~－23.11)、住院天数(WMD =－4.00,95%CI －4.60 ~－3.40)均明显减少,宫旁切除长度明显减小(WMD =－0.10,95%CI －0.15 ~－0.06),手术总时间延长(WMD =30.74,95%CI 16.66~44.82);而在淋巴结活检数、术中出血量、术后总体复发率等方面比较差异无统计学意义。结论 NSRH治疗早期宫颈癌具备安全性和可行性,在缩短膀胱功能恢复时间、肠道功能恢复时间及住院时间等方面有一定优势。     

Radical hysterectomy for cervical cancer amongst women infected with the human immunodeficiency virus

Invasive cervical cancer and human immunodeficiency virus (HIV) infection are an epidemic in South Africa. Most HIV-infected patients with cervical cancer present with late-stage disease. Whilst the literature describes the outcome of such women with preneoplastic cervical lesions, the management of early-stage invasive cervical cancer and HIV is lacking. We present our experience with such patients.     

Radical hysterectomy for recurrent or persistent cervical cancer following radiation therapy

Abstract. Maneo A, Landoni F, Cormio G, Colombo A, Mangioni C. Radical hysterectomy for recurrent or persistent cervical cancer following radiation therapy.
The objective of this paper was to determine the role of radical hysterectomy in persistent or recurrent cervical cancer after primary radiation therapy.
Between 1982 and 1995, 34 patients underwent radical hysterectomy for persistent ( n = 15) or recurrent ( n = 19) cervical cancer after primary radiotherapy. Univariate analysis using log-rank comparison of survival curves was conducted to identify clinical and pathologic factors predictive of survival. The median tumor size at the time of recurrence or persistence was 3.2 cm (range 1–6 cm). 24 patients (70%) had recurrence limited to the uterine cervix; four (12%) had vaginal involvement and six (18%) had early parametrial involvement. No treatment-related deaths were observed. Eighteen major complications (grade III-IV) occurred in 15 cases (44%); 5 patients experienced a fistula. Mean follow-up time was 81 months (range 33–192 months). Recurrent disease was documented in 20 patients (59%), and median time to recurrence was 37 months (range 4–56 months). Fifteen patients (44%) are alive without evidence of disease at a median survival of 81 months (range 33–192), and 18 patients (53%) died of disease with a median survival of 22 months (range 7–106). One patient died of intercurrent disease. Actuarial 5-year survival rate for the whole group is 49%. Patients with FIGO stage IB-IIA at primary diagnosis, no clinical parametrial involvement, and small (≤ 4 cm) tumor diameter at the time of recurrence show a good prognosis (11/17 alive NED) compared to patients who do not fit the above mentioned criteria (4/17 NED, P = 0.01). We conclude that radical hysterectomy can be offered as an alternative procedure to exenteration only in highly selected patients.     

Radical hysterectomy for stage IIB cervical cancer: a review

Patients with stage IIB cervical cancer in some countries in Europe and Asia especially in Japan are usually treated with radical hysterectomy and pelvic lymphadenectomy. Extrauterine diseases, ie, nodal metastases, parametrial invasion, and intraperitoneal spread, can be readily identified. We present the literature review of radical hysterectomy in stage IIB cervical cancer by searching data since 1980 from Medline, and we found that the parametrial involvement of patients in this stage was only 21-55%, the incidence of pelvic node metastases was about 35-45%, and 5-year survival rate was between 55% and 77%. Lymph node metastases and the number of positive nodes were significant prognostic factors of patients in this stage.     

重视子宫颈癌的微创治疗

"治疗"的含意为消除疾病,减少患者痛苦,促使恢复健康的医疗措施.妇科肿瘤的医疗措施主要包括手术、化疗及放疗.这些措施都具有一定的"双刃"作用,既可消除疾病,减少患者痛苦,也可因去除病灶、治疗疾病而损害正常组织,或产生严重的并发症."微创治疗"亦即为在获得治疗目的同时,尽可能地减少手术、化疗及放疗对患者产生的"创伤",...     

Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy

We determined the prevalence of sexual dysfunction in women with early-stage cervical cancer who had undergone radical hysterectomy in three institutions of Thailand. An interview was conducted according to the structured questionnaire composing of seven domains of sexual function: frequency, desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia. From 105 women included in the study, mean age was 45.3 +/- 7.8 years. Seventy-five (71.4%) were in premenopausal period. Eight out of 105 women (7.6%) never resumed their sexual intercourse after radical hysterectomy, 97 women resumed their sexual intercourse during 1-36 months postoperation (median, 4 months). Dyspareunia was increased in approximately 37% of women, while the other six domains of sexual function were decreased, ranging from approximately 40-60%. Of interest, only 10.5% of these cervical cancer women had some information of sexual function from medical or paramedical personnel, 17.1% obtained it from other laymen or public media, and 61.9% had never had it from any resources. Our conclusion is-sexual dysfunction is a common problem after cervical cancer treatment, but it has not been well aware of. These findings may necessitate health care providers to be more considerate on this problem.