腹式根治性宫颈切除术的手术、肿瘤学和产科结局 - 系统文献回顾。

Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy - a systematic literature review.

机构信息

Department of Gynecologic Oncology, Instituto de Cancerología Las Américas, Medellín, Colombia.

出版信息

Gynecol Oncol. 2013 Oct;131(1):77-82. doi: 10.1016/j.ygyno.2013.06.010. Epub 2013 Jun 14.

DOI:10.1016/j.ygyno.2013.06.010

PMID:23769758

Abstract

OBJECTIVE

Radical trachelectomy is a standard treatment for selected patients with early-stage cervical cancer. Outcomes are well established for vaginal radical trachelectomy (VRT), but not for abdominal radical trachelectomy (ART).

METHODS

We searched MEDLINE, EMBASE, and CINAHL (October 1997 through October 2012) using the terms: uterine cervix neoplasms, cervical cancer, abdominal radical trachelectomy, vaginal radical trachelectomy, fertility sparing, and fertility preservation. We included original articles, case series, and case reports. Excluded were review articles, articles with duplicate patient information, and articles not in English.

RESULTS

We identified 485 patients. Ages ranged from 6 to 44 years. The most common stage was IB1 (331/464; 71%), and the most common histologic subtype was squamous cell carcinoma (330/470; 70%). Operative times ranged from 110 to 586 min. Blood loss ranged from 50 to 5568 mL. Three intraoperative complications were reported. Forty-seven patients (10%) had conversion to radical hysterectomy. One hundred fifty-five patients (35%) had a postoperative complication. The most frequent postoperative complication was cervical stenosis (n=42; 9.5%). The median follow-up time was 31.6 months (range, 1-124). Sixteen patients (3.8%) had disease recurrence. Two patients (0.4%) died of disease. A total of 413 patients (85%) were able to maintain their fertility. A total of 113 patients (38%) attempted to get pregnant, and 67 of them (59.3%) were able to conceive.

CONCLUSION

ART is a safe treatment option in patients with early-stage cervical cancer interested in preserving fertility.

摘要

目的

根治性宫颈切除术是治疗特定早期宫颈癌患者的标准治疗方法。经阴道根治性宫颈切除术（VRT）的结果已得到充分确立，但经腹根治性宫颈切除术（ART）的结果尚未确立。

方法

我们使用以下术语在 MEDLINE、EMBASE 和 CINAHL（1997 年 10 月至 2012 年 10 月）中进行了搜索：子宫颈肿瘤、宫颈癌、根治性宫颈切除术、经阴道根治性宫颈切除术、保留生育力和生育力保存。我们纳入了原始文章、病例系列和病例报告。排除了综述文章、有重复患者信息的文章和非英文文章。

结果

我们确定了 485 名患者。年龄范围为 6 至 44 岁。最常见的分期为 IB1（331/464；71%），最常见的组织学亚型为鳞状细胞癌（330/470；70%）。手术时间范围为 110 至 586 分钟。出血量范围为 50 至 5568 毫升。报告了 3 例术中并发症。47 名患者（10%）转为根治性子宫切除术。155 名患者（35%）出现术后并发症。最常见的术后并发症是宫颈狭窄（n=42；9.5%）。中位随访时间为 31.6 个月（范围，1-124）。16 名患者（3.8%）出现疾病复发。2 名患者（0.4%）死于疾病。共有 413 名患者（85%）能够维持生育能力。共有 113 名患者（38%）试图怀孕，其中 67 名（59.3%）能够受孕。