Bergmark K, Avall-Lundqvist E, Dickman P W, Henningsohn L, Steineck G
Gynecological Oncology, Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, Stockholm, Sweden.
Int J Gynecol Cancer. 2006 May-Jun;16(3):1130-9. doi: 10.1111/j.1525-1438.2006.00601.x.
The aim of the study was to acquire knowledge that can be used to refine radical hysterectomy to improve quality-of-life outcome. Data were collected in 1996-1997 by means of an anonymous postal questionnaire in a follow-up study of two cohorts (patients and population controls). We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-1992 at the seven departments of gynecological oncology in Sweden and 489 population controls. Ninety three (37%) of the 256 women with a history of cervical cancer who answered the questionnaire (77%) were treated with surgery alone. Three-hundred fifty population controls answered the questionnaire (72%). Women treated with radical hysterectomy, as compared with controls, had an 8-fold increase in symptoms indicating lymphedema (25% reported distress due to lymphedema), a nearly 9-fold increase in difficult emptying of the bladder, and a 22-fold increase in the need to strain to initiate bladder evacuation. Ninety percent of the patients were not willing to trade off survival for freedom from symptoms. Avoiding to induce long-term lymphedema or bladder-emptying difficulties would probably improve quality of life after radical hysterectomy (to cure cervical cancer). Few women want to compromise survival to avoid long-term symptoms.
本研究的目的是获取可用于改进根治性子宫切除术以改善生活质量结果的知识。在一项对两个队列（患者和人群对照）的随访研究中，于1996 - 1997年通过匿名邮政问卷收集数据。我们试图纳入1991 - 1992年在瑞典七个妇科肿瘤科室登记的所有332例IB - IIA期宫颈癌患者以及489名人群对照。在256名有宫颈癌病史且回复问卷的女性中（回复率77%），93名（37%）仅接受了手术治疗。350名人群对照回复了问卷（回复率72%）。与对照组相比，接受根治性子宫切除术的女性出现淋巴水肿症状的几率增加了8倍（25%报告因淋巴水肿而痛苦），膀胱排空困难的几率增加了近9倍，需要用力才能开始排尿的几率增加了22倍。90%的患者不愿意以生存为代价换取无症状。避免引发长期淋巴水肿或膀胱排空困难可能会改善根治性子宫切除术后（用于治疗宫颈癌）的生活质量。很少有女性愿意以牺牲生存为代价来避免长期症状。
