早期宫颈癌患者保留生育功能的治疗策略研究进展

广泛全子宫切除术和盆腔淋巴结切除术仍然是年轻早期宫颈癌患者治疗的常规术式，患者因此丧失生育能力。本文针对国内外最新研究进展，回顾性分析宫颈癌根治术后宫旁、阴道旁及淋巴结转移情况，发现早期宫颈癌患者中仅27%存在淋巴结转移，并对前哨淋巴结切除术的临床应用前景以及为保留生育功能而进行“最小而有效的”手术治疗方式的研究现状进行总结讨论。前哨淋巴结切除术可提高术中诊断淋巴结转移与否的准确度，减少不必要的过度治疗，目前有替代盆腔淋巴结切除术的趋势。目前保留生育功能的手术主要有6种术式，即扩大宫颈锥切术、单纯宫颈切除术、经阴道广泛性宫颈切除术、开腹广泛性宫颈切除术、腹腔镜下广泛性宫颈切除术和机器人辅助腹腔镜下广泛性宫颈切除术。对于病灶＞2 cm的患者，推荐先行新辅助化疗（NACT）3~4个疗程后，再结合妇科检查及影像学证据，选择宫颈切除范围和具体术式。

Research Progress on the Fertility-Sparing Therapy in Early Cervical Cancer Patients

Radical hysterectomy and pelvic lymphadenectomy is still the routine treatment for young patients with early cervical cancer, which leads to loss of their fertility. In this review, we retrospectively analyze the latest research progress of vagina and lymph node metastasis after radical surgery of cervical cancer both at home and abroad, finding that only 27%of the patients with early cervical cancer have lymph node metastasis, and then conclude the clinical application prospects of sentinel lymphadenectomy and the research status of"minimal and effective"surgical treatment for fertility-sparing therapy. Sentinel lymph node resection can improve the accuracy of the intraoperative diagnosis of lymph node metastasis, reduces unnecessary excessive treatment, which can be an alternative to the pelvic lymphadenectomy. At present there are 6 kinds of fertility-sparing operations including cervical conization, simple cervical resection, wide resection of the cervical, vaginal radical trachelectomy, laporotomic radical trachelectomy, and laparoscopic robot assisted laparoscopic resection of the cervix. For patients with lesions>2 cm, 3-4 course NACT before operation are recommended, then combine gynecologic examination and radiographic evidence, decide the cervical resection range and choose the operation method.