219例宫颈癌患者根治性子宫切除术后并发症分析

Wu Kun, Zhang Wen-hua, Zhang Rong, Li Hua, Bai Ping, Li Xiao-guang

Department of Gynecological Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Zhonghua Zhong Liu Za Zhi. 2006 Apr;28(4):316-9.

OBJECTIVE

To analyze the causes and therapeutic approaches for the complications of radical hysterectomy plus pelvic lymphadenectomy in cervical cancer patients.

METHODS

From Jan. 1995 to Dec. 2003, 219 such patients were treated by radical hysterectomy plus pelvic lymphadenectomy. The stages were: 26 stage IA (17 stage IA1 and 9 stage IA2) (11.9%); 142 stage IB (78 stage IB1, 64 stage IB2) (64.8%); 40 stage IIA (18.3%) and 3 stage IIB (1.4%). 204 patients in this series were treated by radical hysterectomy plus pelvic lymphadenectomy and 15 by modified radical hysterectomy with pelvic lymphadenectomy.

RESULTS

a total of 49 patients (22.4%) developed postoperative complications. The major complications included: bladder dysfunction (10.0%); formation of lymphocysts (7.8%); wound infection (6.8%); hydronephrosis (1.4%) and formation of ureteral fistulas (0.5%). The patients in the group treated by radical hysterectomy plus pelvic lymphadenectomy was likely to develop postoperative complication compared with the patients in the group by modified radical hysterectomy plus pelvic lymphadenectomy (24.0% versus 0, P = 0.067). The postoperative complication incidence in the patients who had preoperative neoadjuvant chemotherapy through intra-arterial catheter or radical radiotherapy in the other hospitals were 50.0% (2/4) and 100.0% (1/1), which were higher than that of the patients treated primarily in our hospital (21.3%, 25.3%) though without statistically significant difference among the groups. Of 52 patients who had previous abdominal surgery history, 13 developed posoperative complications, there was no significant difference between the patients with or without previous abdominal surgery history. The complication incidence of 87 patients treated with preoperative afterloaded radiotherapy was higher than that of 124 patients primarily treated by surgery (25.3% versus 19.4%), but the difference between two groups was statistically not significant (P = 0.239).

CONCLUSION

The complication of radical hysterectomy with pelvic lymphadenectomy is correlated with the surgery mode. Preoperative afterloaded radiotherapy may not increase postoperative complication incidence. Properly reducing the extent of surgery may decrease incidence of complications.

目的

分析宫颈癌患者行根治性子宫切除术加盆腔淋巴结清扫术后并发症的原因及治疗方法。

方法

1995年1月至2003年12月，219例患者接受了根治性子宫切除术加盆腔淋巴结清扫术。分期为：26例IA期（17例IA1期和9例IA2期）（11.9%）；142例IB期（78例IB1期，64例IB2期）（64.8%）；40例IIA期（18.3%）和3例IIB期（1.4%）。本系列中204例患者接受了根治性子宫切除术加盆腔淋巴结清扫术，15例接受了改良根治性子宫切除术加盆腔淋巴结清扫术。

结果

共有49例患者（22.4%）出现术后并发症。主要并发症包括：膀胱功能障碍（10.0%）；淋巴囊肿形成（7.8%）；伤口感染（6.8%）；肾盂积水（1.4%）和输尿管瘘形成（0.5%）。与接受改良根治性子宫切除术加盆腔淋巴结清扫术的患者相比，接受根治性子宫切除术加盆腔淋巴结清扫术的患者术后更易发生并发症（24.0%对0，P = 0.067）。在其他医院通过动脉导管进行术前新辅助化疗或根治性放疗的患者术后并发症发生率分别为50.0%（2/4）和100.0%（1/1），虽高于在我院接受初次治疗的患者（21.3%，25.3%），但组间差异无统计学意义。在52例有腹部手术史的患者中，13例出现术后并发症，有腹部手术史和无腹部手术史的患者之间无显著差异。87例接受术前高剂量率后装放疗的患者并发症发生率高于124例主要接受手术治疗的患者（25.3%对19.4%），但两组之间的差异无统计学意义（P = 0.239）。