Department of Gynecologic Oncology, Unit 1362, MD Anderson Cancer Center, University of Texas, Houston, TX 77230-1439, USA.
Int J Clin Oncol. 2010 Feb;15(1):77-81. doi: 10.1007/s10147-009-0014-4.
Cesarean radical hysterectomy (CRH) for invasive cervical cancer during pregnancy is characterized by heavy blood loss. Any surgical modifications made in an attempt to reduce the blood loss are valuable. Our study was designed to evaluate the efficacy of amputating the uterine corpus during CRH.
All cases of radical hysterectomy (RH) were evaluated. Cases were divided into: (a) cesarean section immediately followed by RH for invasive cervical cancer complicating pregnancy (CRH group); and (b) RH for nonpregnant subjects (RH group). The information abstracted included estimated blood loss (EBL), operative time, intraoperative transfusion, and use of amputation of uterine corpus during CRH. Nonparametric tests were used for the statistical analysis.
There were five CRH cases (3 for CRH with amputation, 2 for CRH without amputation) and 209 RH cases were evaluated for statistics during the study period. The difference in mean operative time between the CRH group and the RH group was not statistically significant: 276.6 min (range 160-425) versus 297.3 min (range 147-645), p = 0.66. The mean EBL for the CRH group was significantly larger than that for the RH group: 2106.6 ml (range 730-4150) versus 858.8 ml (range 150-4770), p < 0.001. Mean operative time and mean EBL for CRH with amputation of uterine corpus were significantly less than those for CRH without amputation of uterine corpus: operative time, 186.0 min (range 160-228) versus 412.5 min (range 400-425), p = 0.043; EBL, 1034.3 ml (range 730-1540) versus 3715.0 ml (range 3280-4150), p = 0.043. No intraoperative tumor exposures were observed in the amputated cases.
Amputation of uterine corpus during CRH for invasive cervical cancer during pregnancy significantly improves the intraoperative performance, although it should be used with care.
妊娠合并浸润性宫颈癌行剖宫产根治性子宫切除术（CRH）的特点是术中出血量较大。任何旨在减少出血量的手术改良都是有价值的。本研究旨在评估在 CRH 中切断子宫体的疗效。
评估所有根治性子宫切除术（RH）病例。病例分为：（a）剖宫产立即行 RH 治疗妊娠合并浸润性宫颈癌（CRH 组）；（b）RH 治疗非妊娠患者（RH 组）。提取的信息包括估计失血量（EBL）、手术时间、术中输血和在 CRH 中使用子宫体切断术。统计分析采用非参数检验。
研究期间，共评估了 5 例 CRH 病例（3 例为 CRH 伴子宫体切断术，2 例为 CRH 无子宫体切断术）和 209 例 RH 病例。CRH 组与 RH 组的平均手术时间差异无统计学意义：276.6 分钟（范围 160-425）与 297.3 分钟（范围 147-645），p=0.66。CRH 组的平均 EBL 明显大于 RH 组：2106.6ml（范围 730-4150）与 858.8ml（范围 150-4770），p<0.001。CRH 伴子宫体切断术的平均手术时间和平均 EBL 明显小于 CRH 无子宫体切断术：手术时间，186.0 分钟（范围 160-228）与 412.5 分钟（范围 400-425），p=0.043；EBL，1034.3ml（范围 730-1540）与 3715.0ml（范围 3280-4150），p=0.043。切断病例术中未见肿瘤暴露。
妊娠合并浸润性宫颈癌行 CRH 时切断子宫体可显著改善术中表现，但应谨慎使用。
