Zeng Si-yuan, Liang Mei-rong, Li Long-yu, Li Ling, Jiang Wei, Zhong Mei-ling
Department of Oncology, Maternal and Child Health Hospital of Jiangxi Province, Nanchang 330006, China.
Zhonghua Zhong Liu Za Zhi. 2013 Jul;35(7):543-6.
To explore the feasibility and safety of transvaginal external fascia trachelectomy to conservatively treat patients with stage Ia1 squamous carcinoma of the uterine cervix (SCC) and cervical intraepithelial neoplasia (CIN) III, who are not suitable to take cold knife conization (CKC).
From July 2002 to September 2010, those patients who had a strong desire to preserve the uterus or fertility but also are confronted with following situations received transvaginal external fascia trachelectomy: CIN III with large area lesion (colposcopically observed lesion area was larger than 3/4 of the cervix), or patients with CIN II-III suffered recurrence or had persistent lesion or positive margin after CKC or LEEP, or patients with CIN II-III upgraded into stage Ia1 SCC through LEEP and pathological confirmation (except for those with lymphovascular space invasion), or CIN III patients complicated with upper vaginal intraepithelial neoplasia (VAIN). Their clinical information and data were reviewed and analyzed.
Among the 79 cases, who underwent transvaginal external fascia trachelectomy, six were stage Ia1 SCC, 61 were CIN III with a large area lesion (23 cases had glandular involvement), three were CIN III complicated with VAIN, six were CIN III with persistent lesion after LEEP, two were CIN III with positive margins after LEEP, and one case had recurrence after conization. The median age of these patients was 33 years old, ranging from 23 to 40 years old. The mean operation time was 39 min (rang 20-60 min), the average amount of bleeding was 40 ml (rang 1-300 ml) and the mean hospital stay was 10 d ( rang 6-17 d). The CIN III patients complicated with VAIN received this surgery with resection of the adjacent vaginal mucosa more than 2 cm in 3.8% (3/79). The median follow-up time was 49 months (8-85 months) and none of these patients had ureteral injury or large amount of intraoperative or postoperative bleeding or post-operative recurrence. No patient complained any effect on their sexual life. Among the five patients with reproductive desire, one was at her 22 w gestation after one induced abortion and one spontaneous abortion, four patients experienced term birth in which three were cesarean section and one was natural labour.
Transvaginal external fascia trachelectomy is a safe and effective conservative treatment for stage Ia1 SCC, CIN III with large area lesion, CIN III complicated with VAIN and CIN II-III suffering recurrence, persistent lesion or positive margins after CKC and others that are not suitable to take CKC.
探讨经阴道外筋膜子宫颈切除术对不适合行冷刀锥切术（CKC）的Ia1期子宫颈鳞状细胞癌（SCC）及子宫颈上皮内瘤变（CIN）III级患者进行保守治疗的可行性及安全性。
2002年7月至2010年9月，对有强烈保留子宫或生育愿望且面临以下情况的患者行经阴道外筋膜子宫颈切除术：CIN III级且病变面积大（阴道镜下观察病变面积大于宫颈的3/4），或CIN II - III级患者在CKC或LEEP术后复发、病变持续存在或切缘阳性，或CIN II - III级患者经LEEP及病理证实升级为Ia1期SCC（无脉管间隙浸润者除外），或CIN III级患者合并阴道上段上皮内瘤变（VAIN）。回顾分析其临床资料。
79例行经阴道外筋膜子宫颈切除术的患者中，Ia1期SCC 6例，CIN III级且病变面积大61例（23例有腺体受累），CIN III级合并VAIN 3例，LEEP术后病变持续存在的CIN III级6例，LEEP术后切缘阳性的CIN III级2例，锥切术后复发1例。这些患者的中位年龄为33岁，年龄范围23至40岁。平均手术时间为39分钟（范围20 - 60分钟），平均出血量为40毫升（范围1 - 300毫升），平均住院天数为10天（范围6 - 17天）。CIN III级合并VAIN的患者中3.8%（3/79）在手术时切除了相邻阴道黏膜2厘米以上。中位随访时间为49个月（8 - 85个月），这些患者均未发生输尿管损伤、术中或术后大量出血或术后复发。无患者主诉对性生活有影响。有生育愿望的5例患者中，1例在1次人工流产和1次自然流产后妊娠22周，4例足月分娩，其中3例剖宫产，1例顺产。
经阴道外筋膜子宫颈切除术对Ia1期SCC、CIN III级且病变面积大、CIN III级合并VAIN以及CIN II - III级在CKC术后复发、病变持续存在或切缘阳性等不适合行CKC的患者是一种安全有效的保守治疗方法。
