广泛性子宫颈切除术加腹膜代阴道延长术治疗早期宫颈癌的临床研究

目的 比较广泛性子宫颈切除术与广泛性子宫切除术治疗早期宫颈癌的临床效果,观察同时行腹膜代阴道延长术能否提高患者术后性生活质量.方法 对比分析24例行腹腔镜下盆腔淋巴结清扫术＋广泛性子宫颈切除术＋腹膜代阴道延长术与32例行腹腔镜下盆腔淋巴结清扫术＋广泛性子宫切除术＋腹膜代阴道延长术的IA2～IB1期宫颈癌患者的临床资料,比较两组的手术时间、术中出血量、并发症、术后恢复情况、复发率及性生活质量等,同时观察行广泛性子宫颈切除术的患者术后月经、妊娠情况.结果 两组间手术成功率、实际手术操作时间、手术出血量、并发症、淋巴结切除数及术后恢复情况比较差异均无统计学意义（P＞0.05）.广泛性子宫颈切除术后均恢复正常月经,术后妊娠率为45.45%（5/11）,足月分娩（剖宫产）率为9.09%（1/11）,流产率为18.18%（2/11）,早产率为18.18%（2/11）.两组术后随访10个月～5年,均无复发,性生活满意.结论 广泛性子宫颈切除术可以达到与广泛性子宫切除术同等的效果,同时行腹膜代阴道延长术提高了患者的生活质量,适用于要求保留生育及生理功能的早期宫颈癌患者.

The clinical study of radical trachelectomy and vagina replacement by peritoneum in the treatment of early stage cervical cancer

Objective To compare the clinical results of radical trachelectomy and radical hysterectomy in treating patients with early stage cervical cancer and to evaluate the feasibility and security of radical trachelectomy and the sexual quality after vagina replacement by peritoneum. Methods Twenty-four women with early stage cervical cancer（ IA2-IB1 ） were performed laparoscopic pelvic lymphadenectomy ＋ radical trachelectomy ＋ vagina replacement by peritoneum, and 32 women with early stage cervical cancer as control were performed laparoscopic pelvic lymphadenectomy ＋ radical hysterectomy ＋ vagina replacement by peritoneum. The operating time, blood lost, complications, recovery post surgery,recurrent rate and sexual quality were compared. For patients who received radical trachelectomy, the menstrual situation and pregnancy outcome post surgery were observed. Results All procedures were performed successfully. There was no significant difference between the two groups in the operating time, blood lost, complications, lymph node number or recovery post surgery （ P 〉 0. 05 ）. Normal menstruation was recovered post surgery in all patients with radical trachelectomy. Pregnant rate was 45.45 % （5/11）, full term delivery rate（Caesarean section） was 9.09% （1/11）, miscarriage rate was 18.18% （2/11） ,and premature delivery rate was 18.18% （2/11）. The two groups were followed up for 10 months to 5 years. There was no recurrent case and all patients were satisfied with their sexual activities. Conclusions Radical trachelectomy and radical hysterectomy have the same treating results for early stage cervical cancer. To prolong the vagina with peritoneum during the procedures can improve the sexual quality. Radical trachelectomy and vagina replacement by peritoneum is a selective treating strategy for patients with early stage cervical cancer who desire to preserve fertility and physiological function.