Protopapas Athanasios, Jardon Kris, Bourdel Nicola, Botchorishvili Revaz, Rabischong Benoit, Mage Gérard, Canis Michel
Centre Hospitalier Universitaire de Clermont-Ferrand Polyclinique Hôtel Dieu, Department of Obstetrics and Gynecology, Clermont-Ferrand Cedex 1, France.
Int J Gynecol Cancer. 2009 May;19(4):712-22. doi: 10.1111/IGC.0b013e3181a3e2be.
Total laparoscopic radical hysterectomy (TLRH) has been reported since the early 1990 s. Although the acceptance of TLRH had been slow over the past 15 years, several teams throughout the world have recently reported promising results in the treatment of early cervical cancer with this procedure. Several modifications of the originally described technique have also been reported. From the currently existing data, these is no doubt that TLRH is technically feasible. Its operative safety profile is comparable to that of radical abdominal hysterectomy (RAH), and there exist sufficient data to suggest that the histopathologic outcome is also similar in terms of local radicality and lymph node yield. The duration of the procedure has become acceptable but remains still longer in comparison to RAH, in most series. It is now evident that with increasing experience, repetition, standardization, and incorporation of technological advances, duration can be reduced considerably and become similar to that of RAH. Total laparoscopic radical hysterectomy is associated with less blood loss, faster recovery and return of bowel function, reduced febrile morbidity, and a better cosmetic result. Nevertheless, shorter hospitalization in comparison to that observed after RAH is not consistently reported, and return of normal bladder activity is similar to that observed after RAH. It is also true that the currently existing recurrence and survival data are still immature to draw safe conclusions on its long-term oncological safety. Probably, the time has come for a multicenter randomized study between TLRH and RAH with participation of the institutions with significant experience in this procedure.
自20世纪90年代初以来，已有全腹腔镜根治性子宫切除术（TLRH）的相关报道。尽管在过去15年里，TLRH的接受度增长缓慢，但世界各地的多个团队最近报告了该手术在早期宫颈癌治疗中取得的令人鼓舞的结果。也有关于最初描述技术的几种改良方法的报道。从现有数据来看，毫无疑问TLRH在技术上是可行的。其手术安全性与根治性腹式子宫切除术（RAH）相当，并且有足够的数据表明，在局部根治性和淋巴结切除量方面，组织病理学结果也相似。在大多数系列研究中，该手术的持续时间已变得可以接受，但与RAH相比仍然较长。现在很明显，随着经验的增加、重复操作、标准化以及技术进步的融入，手术持续时间可以大幅缩短并与RAH相似。全腹腔镜根治性子宫切除术的出血量较少，肠道功能恢复更快，发热发病率降低，美容效果更好。然而，与RAH术后相比，住院时间缩短的情况并非一直都有报道，膀胱功能恢复正常的情况与RAH术后相似。目前现有的复发和生存数据仍不成熟，无法就其长期肿瘤学安全性得出可靠结论。或许，开展一项由在此手术方面有丰富经验的机构参与的TLRH与RAH之间的多中心随机研究的时机已经成熟。
