Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic.
Int J Gynecol Cancer. 2009 Nov;19(8):1407-11. doi: 10.1111/IGC.0b013e3181b9549a.
Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. In comparison with vaginal radical trachelectomy, the published results of ART are so far limited.
Enrolled were women referred for ART either by laparoscopy or laparotomy. The main inclusion criterion was stage IA2 or IB1 with a cranial extent that allows for preservation of at least 1 cm of the endocervical canal.
A total of 24 women were referred for the procedure, but fertility could not be preserved in 7 (29%) of them. Four women underwent immediate completion of radical hysterectomy because of a positive cranial surgical margin (n = 2) or sentinel node macrometastasis (n = 2) on frozen section. We found no correlation between tumor volume and inability to preserve fertility. A positive sentinel node was identified in 4 patients (17%); there were no false-negative results. Of the 9 women (53%) who have tried to conceive so far, 6 (67%) have conceived and 5 given birth, 2 of which were premature deliveries.
Fertility cannot be preserved because of positive cranial margins or involved lymph nodes in almost one third of patients originally referred for radical trachelectomy. The main criterion for the selection of suitable patients should be the cranial extent of the tumor. Abdominal radical trachelectomy allows for achievement of satisfactory obstetrical outcomes.
腹式根治性宫颈切除术（ART）是早期宫颈癌保留生育功能的手术之一。与经阴道根治性宫颈切除术相比，目前发表的 ART 结果有限。
纳入因腹腔镜或剖腹术而接受 ART 的女性。主要纳入标准为 IA2 期或 IB1 期，且肿瘤头端范围允许保留至少 1 cm 的宫颈内口。
共有 24 名女性被推荐进行该手术，但其中 7 名（29%）无法保留生育能力。4 名女性因冰冻切片显示头端手术切缘阳性（n=2）或前哨淋巴结宏转移（n=2）而立即行根治性子宫切除术。我们未发现肿瘤体积与无法保留生育能力之间存在相关性。4 名患者（17%）的前哨淋巴结为阳性；无假阴性结果。迄今为止，9 名尝试怀孕的女性中有 6 名（67%）已怀孕，5 名已分娩，其中 2 名为早产。
由于最初被推荐行根治性宫颈切除术的患者中近三分之一存在头端切缘阳性或淋巴结受累，因此无法保留生育能力。选择合适患者的主要标准应为肿瘤的头端范围。腹式根治性宫颈切除术可实现满意的产科结局。
