Malzoni Mario, Tinelli Raffaele, Cosentino Francesco, Perone Ciro, Vicario Vincenza
Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):584-90. doi: 10.1016/j.jmig.2007.04.001.
The purpose of this study was to retrospectively evaluate, in a series of 65 patients, the feasibility, morbidity, and safety of total laparoscopic radical hysterectomy with lymphadenectomy for early cervical carcinoma.
Retrospective, nonrandomized study (Canadian Task Force classification II-2).
Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
Sixty-five nonconsecutive patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ia1 with lymphvascular space involvement, Ia2, and Ib1 early cervical cancer.
Fourteen patients underwent a laparoscopic class II procedure, and 51 patients underwent a class III procedure according to the Piver classification. All the patients underwent total laparoscopic radical hysterectomy with pelvic lymphadenectomy during the study period, and none of the surgeries required conversion to laparotomy. Paraaortic lymphadenectomy is not routinely performed unless suspicious pelvic lymph nodes are confirmed to have metastatic disease on frozen section evaluation.
Fifty-six patients had squamous cell carcinoma; 7 patients had adenocarcinomas, and 2 had adenosquamous carcinoma. The mean age was 40.5 years (95% CI 27.7-69.1) and the SD was +/- 7.5. The median weight was 56.2 kg (range 44-75 kg). The median operative time was 196 minutes (range 182-240 minutes), and the surgical margins were free of disease in all cases. The median blood loss was 55 mL (range 30-80 mL). No patient required an intraoperative blood transfusion. The median length of hospital stay was 4 days (range 3-7 days).
Laparoscopic treatment of cervical cancer offers patients the potential benefits of decreased discomfort with decreased convalescence time, but it should be reserved for oncologic surgeons trained in extensive laparoscopic procedures.
本研究旨在回顾性评估65例早期宫颈癌患者行全腹腔镜根治性子宫切除术加淋巴结清扫术的可行性、发病率及安全性。
回顾性、非随机研究（加拿大工作组分类II-2）。
意大利阿韦利诺马尔佐尼医疗中心高级妇科内镜中心。
65例非连续性国际妇产科联盟（FIGO）Ia1期伴脉管间隙受累、Ia2期和Ib1期早期宫颈癌患者。
根据Piver分类，14例患者接受腹腔镜II级手术，51例患者接受III级手术。在研究期间，所有患者均接受全腹腔镜根治性子宫切除术加盆腔淋巴结清扫术，且无一例手术需要转为开腹手术。除非在冰冻切片评估中证实可疑盆腔淋巴结有转移疾病，否则不常规进行腹主动脉旁淋巴结清扫术。
56例患者为鳞状细胞癌；7例为腺癌，2例为腺鳞癌。平均年龄为40.5岁（95%CI 27.7-69.1），标准差为±7.5。中位数体重为56.2kg（范围44-75kg）。中位手术时间为196分钟（范围182-240分钟），所有病例手术切缘均无病变。中位失血量为55mL（范围30-80mL）。无患者需要术中输血。中位住院时间为4天（范围3-7天）。
腹腔镜治疗宫颈癌可为患者带来不适减轻、康复时间缩短的潜在益处，但应仅由接受过广泛腹腔镜手术培训的肿瘤外科医生实施。
