Vaginal Radical Hysterectomy versus Abdominal Radical Hysterectomy in the Treatment of Early-Stage Cervical Cancer

The purpose of this study is to compare the safety, efficacy, and potential benefits of vaginal radical hysterectomy (VRH) versus abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer. We reviewed the charts of our first 52 patients with cervical cancer who underwent a laparoscopic pelvic lymphadenectomy (LPL), followed either by a VRH (Schauta) in 25 cases or ARH in 27 cases. For the 52 patients, the mean lymph nodes count obtained by LPL was 27 (range 8–59), and the only complication was an external iliac vein trauma requiring laparotomy. Both VRH and ARH groups were comparable in terms of age, weight, parity, stage, histology, and tumor volume. The mean blood loss was 400 cc for VRH vs 450 cc for ARH, operating time was 270 min vs 280 min, blood transfusion in 5 vs 4 women, and postoperative stay was 7 days for both groups. The only intraoperative complication in addition to the vein trauma was a cystotomy which occurred in 2 VRH patients. Febrile morbidity was noted in 4 VRH patients vs 9 ARH patients. There were one preperitoneal abscess and one hematoma in the VRH group vs 4 wound infections and 1 hematoma after ARH. Ileus occurred in 1 VRH vs 4 ARH patients. The current mean follow-up time is 27 months (8–52) and there has been one recurrence so far in the ARH group. Even though this is a retrospective study, our data indicate that VRH and ARH are comparable, except for the absence of an abdominal scar and less febrile morbidity with the vaginal approach. However, in our opinion, the main advantage in learning the Schauta operation is that the experience gained allows one to offer radical trachelectomy to selected young patients who wish to preserve their fertility.     

Cervical-Vaginal Bacterial Flora in Patients with Cervical Carcinoma Treated with Irradiation and Febrile Morbidity During Intracavitary Radium Therapy

The cervical-vaginal bacterial flora of 57 patients with invasive carcinoma of the cervix were found to be identical to those reported in studies of different population groups, except for a lower frequency of anaerobic bacteria. Radiation suppressed significantly both the aerobic and anaerobic bacteria. Following 4,000 rads of external irradiation, 47.4% of the cervical cultures were bacteriologically sterile. During the first and second radium treatment, 21% and 25.5% of the patients respectively developed fever of 38 degrees C or more, the cause of which could not definitely be established. The significance of fever during radium treatment is discussed.     

The Treatment of Recurrent Cervical Cancer

Summary: A retrospective study was made of 110 patients treated for recurrent cervical cancer at National Women's Hospital, Auckland, New Zealand, between 1946 and 1970. The methods of re-treatment tended to be conservative and gave comparable results to those obtained from other centres where a more aggressive policy was followed.
The patient who receives treatment for recurrent cancer of the cervix may have a small chance of cure, even if only palliation is intended, and has a definite advantage over the patient who receives no treatment.     

Comparison of Survival Outcomes after Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Patients with Cervical Cancer

ObjectiveA meta-analysis was performed to compare survival outcomes including disease-free survival (DFS) between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in patients with cervical cancer.Data SourcesWe searched PubMed, EMBASE, Google scholar, and the Cochrane library for studies published between December 2004 and May 2020. Manual searches of related articles and relevant bibliographies of published studies were also performed.Methods of Study SelectionTwo researchers independently extracted the data. Studies with survival outcome information were included.Tabulation, Integration, and ResultsA total of 36 eligible clinical trials were included in this meta-analysis. When all studies were pooled, the hazard ratio (HR) of LRH for the risk of DFS and overall survival (OS) compared with ARH was 1.24 (95% confidence interval [CI], 1.09–1.41; p = .001; I² = 37.5%) and 1.27 (95% CI, 1.04–1.56; p = .020; I² = 45.5%), respectively. In a subgroup analysis, significant harmful effects of DFS in patients with LRH increased in studies using the HR presented by the article (HR, 1.41; 95% CI, 1.21–1.64; p <.001), matched retrospective design (HR, 1.49; 95% CI, 1.19–1.88; p = .001), large-scale studies (HR, 1.34; 95% CI, 1.16–1.55; p <.001), and studies published after the Laparoscopic Approach to Cervical Cancer trial (HR, 1.46; 95% CI, 1.25–1.71; p <.001). However, LRH did not affect DFS (HR, 1.04; 95% CI, 0.59–1.81; p = .898) or OS (HR, 0.57; 95% CI, 0.31–1.05; p = .073) of patients with cervical cancer with cervical masses <2 cm.ConclusionThis meta-analysis demonstrated that LRH was associated with higher recurrence rates than ARH. However, LRH showed similar recurrence and OS among patients with cervical masses <2 cm (Centre for Reviews and Dissemination 42020191713).     

宫颈癌腹腔镜根治性子宫切除术研究进展

随着腹腔镜设备与医生操作技术的进步以及公众对腹腔镜微创手术的认可,腹腔镜根治性子宫切除(laparoscopic radical hysterectomy,LRH)加盆腔淋巴结清扫术(pelvic lymphadencetomy)已成为治疗早期宫颈癌新的手术方式。全球多个中心相继报道的将近二千例宫颈癌LRH的研究均取得较满意的结果,但目前获得的关于复发和存活的数据尚不足以得出LRH治疗宫颈癌具有远期安全性的结论。综述宫颈癌腹腔镜手术的研究现状及进展。     

新辅助化疗在宫颈癌治疗中的作用

新辅助化疗的概念于1983年首次提出。目前新辅助化疗在宫颈癌治疗方面虽仍有争议,但随着医疗技术的不断发展其作用优势逐步显现。新辅助化疗不但可以缩小肿瘤体积、提高手术切除率,而且可延长妊娠期宫颈癌患者的妊娠时间,使其获得存活新生儿。故新辅助化疗的出现为局部晚期宫颈癌患者、晚期宫颈癌患者和妊娠期宫颈癌患者的治疗提供了新的思路。综述新辅助化疗概念的提出、所存争议、作用机制及其在宫颈癌综合治疗中的作用。     

广泛子宫切除术的临床现状点评

广泛子宫切除术的临床应用已逾百年,在手术技巧、手术器械与辅助设备、无菌技术与麻醉技术等不断提高的基础上,手术路径从经腹腔、经阴道发展到经腹腔镜完成,手术创伤逐渐减少,而手术安全性也得到保证.根据手术范围的不同,广泛子宫切除术分为A、B两类.分别适宜不同临床分期宫颈癌的治疗.大量临床观察证实,在ⅠB-ⅡA期宫颈癌患者中,广泛子宫切除术与放疗的疗效相近.     

广泛子宫切除术的临床现状点评

广泛子宫切除术的临床应用已逾百年,在手术技巧、手术器械与辅助设备、无菌技术与麻醉技术等不断提高的基础上,手术路径从经腹腔、经阴道发展到经腹腔镜完成,手术创伤逐渐减少,而手术安全性也得到保证。根据手术范围的不同,广泛子宫切除术分为A、B两类,分别适宜不同临床分期宫颈癌的治疗。大量临床观察证实,在ⅠB～ⅡA期宫颈癌患者中,广泛子宫切除术与放疗的疗效相近。     

局部晚期宫颈癌临床治疗新进展

宫颈癌是严重威胁女性健康的恶性肿瘤之一,其中局部晚期宫颈癌（LACC）有病灶大、手术困难、预后差等特点,关于其治疗方案争议不断,主要推荐的治疗方案有：盆腔外照射+顺铂同期化疗+阴道近距离放疗,广泛性子宫切除术+盆腔淋巴结切除±主动脉旁淋巴结取样,放化疗后进行辅助性子宫切除术。而在临床治疗中,由于各地区放疗水平不同和患者个体化差异,目前对LACC的治疗方案仍存在多样性。预防性半扩展区域调强适形放疗可以在达到与传统扩展区域放疗相似治疗效果的同时减少并发症的发生,同步放化疗同时加局部热疗可以增强患者对治疗的耐受性。腹主动脉旁淋巴结清扫或活检不一定改善LACC的预后,但可帮助判断预后,对已有髂总动脉旁淋巴结转移的患者有积极意义。对于腔内放疗技术不成熟地区的患者,盆腔外照射加同步化疗后行Ⅰ型筋膜外子宫切除术是可行的治疗方案。     

妊娠合并宫颈癌的诊断及治疗进展

妊娠期生殖系统恶性肿瘤的诊断及治疗是对广大妇产科医生的一个极大挑战。其诊治取决于诊断时的妊娠周数、肿瘤的分期和组织学类型、妊娠妇女对继续妊娠或放弃胎儿的意愿及对未来生育的要求。目前临床上对于如何治疗此类特殊的临床问题尚无明确的规范。综述妊娠期生殖系统恶性肿瘤中最常见的妊娠合并宫颈癌的诊断和治疗。     

扩大性宫旁切除术在宫颈癌治疗中的应用

宫颈癌是最常见的妇科恶性肿瘤之一,根治性子宫切除术与常规淋巴结清扫是手术治疗宫颈癌的标准术式,但宫颈癌患者生存率在近数十年中仍未得到显著提高,局部复发是目前影响宫颈癌伴淋巴结转移患者生存率的原因,有证据表明提高患者的局部控制情况就能改善生存率,扩大性子宫旁组织切除术(laterally extended parametrectomy,LEP)可更大范围切除盆腔侧壁淋巴组织,是临床上扩大性子宫切除治疗宫颈癌的一种有效术式。现综述LEP在宫颈癌治疗应用中的理论、疗效、争议、展望,以期为宫颈癌治疗提供另一种手术方式。     

宫颈癌的筛查及诊治进展

宫颈癌筛查是早期发现宫颈癌的重要手段,由于流行病学及对乳头瘤病毒研究的进展,美国妇产科学会(ACOG)对宫颈癌筛查的起始时间及频率等作了重要修改.鳞状细胞抗原检测对宫颈癌诊断及病情监测起重要作用.宫颈癌治疗手段的改革与创新,如保留生育功能的宫颈广泛性切除术、新辅助化疗、同步放化疗、调强放疗等,使宫颈癌的治疗效果不断提高.     

Chemotherapy Followed by Radiotherapy versus Radiotherapy Alone in Locally Advanced Cervical Cancer: A Randomized Study

Between August 1990 and January 1992, 184 patients with squamous cell carcinoma of the cervix, FIGO stage IIB-IVA, were randomized to receive either two cycles of bleomycin, ifosfamide-mesna, and cis-platinum (BIP) chemotherapy (CT) followed by radiotherapy (RT) ("CT-RT group," n = 94) or RT alone (RT group, n = 90). In the CT-RT group, of 89 evaluable patients, 64 responded: complete response (CR) 4 (4.5%) and partial response 60 (67.5%). Of the remaining 25 patients, 23 had stable disease and 2 progressed. Eighty of 89 patients completed RT as planned. Following RT 56 (70%) achieved CR, 19 (23.7%) had residual disease, and 5 (6.3%) had progressed. CT responders had a better response to RT: 83% (49/59) vs 33.3% (7/21), P < 0.01. The stage of disease, histologic grade, duration of symptoms, and history of smoking had no influence on the response to CT. Patients aged >45 years and those with lib >10 g/dl had significantly better response. Nausea/vomiting, alopecia, grade I-II myelosuppression, diarrhea, and mucositis were the major side effects of CT. Two patients died of CT toxicity. In the RT group, 88 patients were evaluable: 61 (69.3%) patients achieved CR, 25 had residual disease, and 2 progressed. The side effects of RT were cystitis, proctitis, and local skin reaction. These were equally distributed between the two groups. There was no significant difference in overall and disease-free survival in the two groups.     

奈达铂与顺铂在宫颈癌同步放化疗中的应用

目的:评价奈达铂和顺铂在宫颈癌同步放化疗(CCRT)中的效果和毒副反应。方法:68例宫颈癌初治患者,随机分为两组,放疗采用盆腔外照射+高剂量率腔内后装放疗,同期化疗与放疗同时开始,每周1次,共6次。奈达铂组同步给予奈达铂40mg/m2,每周1次,化疗6周;顺铂组同步给予顺铂40mg/m2,每周1次,化疗6周。观察两组的治疗效果和毒副反应,并进行比较。结果:所有患者完成了CCRT,奈达铂组与顺铂组的1、2、3年生存率分别为91.2%、82.4%、76.5%和85.3%、73.5%、70.6%(P>0.05);1、2、3年无瘤生存率分别为88.2%、73.5%、64.7%和82.3%、64.7%、61.8%(P>0.05)。两组Ⅰ、Ⅱ级厌食反应分别为17.6%(6/34)和35.3%(12/34)(P<0.05),Ⅰ、Ⅱ级恶心呕吐反应分别为20.6%(7/34)和55.9%(19/34)(P<0.05);血红蛋白下降两组分别为17.6%(6/34)和35.3%(12/34)(P<0.05);Ⅰ、Ⅱ级肾脏毒性分别为5.9%(2/34)和32.4%(11/34)(P<0.05);Ⅰ、Ⅱ级血小板减少分别为38.2%(1...     

新辅助化疗治疗宫颈癌31例临床观察

目的:探讨新辅助化疗在Ⅰb2~Ⅱb期宫颈癌辅助治疗中的临床效果。方法:31例宫颈癌患者,术前采用1~3个疗程的静脉化疗,之后全部行宫颈癌根治术。通过观察患者病灶大小的改变、化疗毒副反应、术中情况、术后病理反应等,评价新辅助化疗在宫颈癌治疗中的作用及安全性。结果:化疗有效率为87.1%,其中5例完全缓解。化疗效果与期别无关,而与病理类型有关,鳞癌的有效率明显高于腺癌(P<0.05)。化疗毒副反应轻微。所有患者化疗后均进行了广泛性子宫切除术及盆腔淋巴清扫术。结论:宫颈癌新辅助化疗是安全有效的。经过新辅助化疗,使某些局部晚期病例得以切除。     

复发性宫颈癌的治疗现状及进展

宫颈癌是女性生殖系统最常见的恶性肿瘤,尽管宫颈癌筛查不断普及,全球宫颈癌发病率较前下降,仍有约75%的宫颈癌患者在初始治疗后2年内复发。复发性宫颈癌严重影响患者的预后及生存率,但目前对于复发性宫颈癌尚无标准化治疗方案。随着肿瘤免疫疗法的出现、放射治疗方法的应用、化疗方案的不断完善以及手术方式的不断改进,复发性宫颈癌患者的治疗方案不断增加,但治疗过程中较高的并发症发生率仍不可忽视。因此,进一步完善复发性宫颈癌的治疗方法并提高患者的生存率仍是复发性宫颈癌治疗的重点和难点。本文就复发性宫颈癌的治疗现状及进展,从手术治疗、化学治疗、免疫治疗及放射治疗方面作一综述,旨在为复发性宫颈癌患者治疗方案的选择提供思路。     

Cervical Cancer: A Preventable Death

Cervical cancer kills 260,000 women annually, and nearly 85% of these deaths occur in developing nations, where it is the leading cause of cancer deaths in women. Disparities of health and poverty play a large role in this high mortality rate. Whereas routine Papanicolaou and human papillomavirus (HPV) testing has dramatically reduced cervical cancer deaths in Western nations, without proper infrastructure, facilities, and medical training, the rates of cervical cancer in developing nations will remain high. Studies on HPV DNA testing and the low-technology method of “screen and treat” are promising. In addition, reducing the cost and increasing the availability of HPV vaccines in developing nations brings hope and promise to the next generation of women.Key words: Cervical cancer, Human papillomavirus, Human papillomavirus DNA testing, Human papillomavirus vaccineIn the 1970s, Harald zur Hausen detected the human papillomavirus (HPV) in warts and cervical cancer, and he subsequently isolated and cloned different strains of HPV. His research concluded that patients infected with HPV types 16 and 18 were at an increased risk of developing cancer. In 2008, Dr. Hausen received the Nobel Prize for his groundbreaking work on HPV.¹Human papillomavirus can cause cancer of the cervix, vagina, vulva, penis, and anus, as well as some head and neck cancers, anogenital warts, and recurrent respiratory papillomatosis. The World Health Organization (WHO) estimates that of the 500,000 new cases annually, 80% affect women between the ages of 15 and 45 years who live in developing nations. It predominantly impacts women living in Latin America and the Caribbean, sub-Saharan Africa, and Southeast Asia (Figure 1). Only 5% of women in these regions have been screened for cervical disease in the past 5 years.Open in a separate windowFigure 1Global burden of cervical cancer greatest in developing countries. Reproduced with permission from Women Deliver. http://www.womendeliver.org/blog/wp-content/uploads/2009/08/cervicalcancer1.jpg.     

Cervical Cancer: A Developmental Perspective

Cervical cancer is a disease that affects women worldwide. In some countries it is the leading cause of death among women. Although the incidence of cervical cancer has decreased with the advent of the Papanicolaou smear, it remains a problem in adult women. Cervical dysplasia most often affects women in their 20s; carcinoma in situ affects women 30 to 39 years of age; and invasive carcinoma affects women older than 40 years. These age groups fall into the final three of Erickson's eight stages of ego development. However, taking a developmental approach in planning nursing interventions for women with cervical cancer has its drawbacks. Much of developmental theory research has been conducted on nonrepresentative samples, with women being underrepresented. A template for exploring patient problems from a life stage (developmental) perspective has been developed within the context of three different nursing diagnoses (sexual dysfunction, spiritual distress, and alteration in family processes).     

宫颈癌治疗后下肢淋巴水肿预防进展

宫颈癌是最常见的女性生殖系统恶性肿瘤,发病率在女性恶性肿瘤中居第2位,严重威胁患者的生命健康.下肢淋巴水肿是宫颈癌治疗后较为常见的并发症,常表现为治疗后发生的患侧下肢慢性进行性无痛性肿胀,并伴有下肢沉重感和疼痛感,严重影响了患者的生活质量.前哨淋巴结活检、新的放疗方法等的应用对早期诊断下肢淋巴水肿起到了十分积极的作用....