Karimi-Zarchi Mojgan, Mousavi Azamsadat, Gilani Mitra Modares, Barooti Esmat, Miratashi-Yazdi Ashrafosadat, Dehghani Atefe
Associate Prof, Gynecologist Oncologist, Shahid Sadoughi University of Medical Science, Yazd, Iran;
Int J Biomed Sci. 2013 Sep;9(3):123-8.
The aim of this study was to describe fertility preservation methods to improve quality of life of early stages of cervical cancer.
Although definite treatment of early stages of cervical cancer including stages IA,IB1 and IIA non-bulky is radial hysterectomy, this method is used in perimenopousal period in which fertility preservation is not important. Whenever fertility preservation is so important, some methods like radical trachelectomy and laparoscopic lymphadenectomy are used to rule out lymphatic metastases.
If any visible lesion on cervix is found, pelvic MRI is helpful and during operation, trachelectomy samples are sent for frozen section and margin study. Radical trachelectomy is done vaginal or abdominal. Overall relapse rate of cervical cancer in radical trachelectomy and radical hysterectomy is the same. Complications of radical trachelectomy include chronic vaginal discharge, abnormal uterine bleeding, dysmenorrhea, inflammation and ulcer due to cercelage, amenorrhea, cervical stenosis and pregnancy complications following trachelectomy including 2(nd) trimester abortion and premature labor following cervical prematurity.The best and preferred method of labor is cesarean section. Neoadjuant chemotherapy followed by radical trachelectomy in large cervical lesions is a suitable treatment. Ultraconservative operations like large cold knife conization, simple trachelectomy with laparoscopic lymphadenectomy and sentinel lymph node mapping are suitable for very small lesions.
本研究旨在描述生育力保存方法，以提高宫颈癌早期患者的生活质量。
尽管宫颈癌早期（包括IA期、IB1期和IIA期非巨块型）的明确治疗方法是根治性子宫切除术，但该方法用于围绝经期，此时生育力保存并不重要。当生育力保存非常重要时，可采用根治性宫颈切除术和腹腔镜淋巴结清扫术等方法来排除淋巴转移。
如果在宫颈发现任何可见病变，盆腔MRI会有帮助，手术期间，将宫颈切除标本送去做冰冻切片和切缘检查。根治性宫颈切除术可经阴道或经腹进行。根治性宫颈切除术和根治性子宫切除术治疗宫颈癌的总体复发率相同。根治性宫颈切除术的并发症包括慢性阴道分泌物、异常子宫出血、痛经、宫颈环扎引起的炎症和溃疡、闭经、宫颈狭窄以及宫颈切除术后的妊娠并发症，包括中期流产和宫颈过早成熟后的早产。最佳且首选的分娩方式是剖宫产。对于较大的宫颈病变，新辅助化疗后行根治性宫颈切除术是一种合适的治疗方法。超保守手术，如大冷刀锥切术、单纯宫颈切除术联合腹腔镜淋巴结清扫术和前哨淋巴结定位术，适用于非常小的病变。
