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[17例局部复发性宫颈癌盆腔廓清术的围手术期及短期随访结果]

[Outcomes of perisurgery and short-time follow-up of pelvic exenteration for 17 cases with locally recurrent cervical cancer].

作者信息

Deng H, Wang J L, Wang Z Q, Li X W, Hu H, Yang B, Zhang X M, Shen K, Guo P, Liang B

机构信息

Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.

Department of Urology, Peking University People's Hospital, Beijing 100044, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2020 Apr 25;55(4):259-265. doi: 10.3760/cma.j.cn112141-20200119-00049.

Abstract

To investigate the perioperative situation and recent effect of pelvic exenteration for patients with locally recurrent cervical cancer. A total of 17 patients with locally recurrent cervical cancer who underwent pelvic exenteration in Peking University People's Hospital from October 2015 to May 2018 were retrospectively analyzed for their clinical and pathological characteristics, surgical conditions, hospitalization costs, postoperative complications, and survival situation. (1) The median age of 17 patients with locally recurrent cervical cancer was 51 years (range 27-64 years). Pathological type: 13 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, and 2 cases of adenosquamous carcinoma. Thirteen patients received radiotherapy during the initial treatment and 4 patients did not receive radiotherapy. (2) Pelvic exenteration was performed in 17 patients with locally recurrent cervical cancer, of which 9 cases were performed with total pelvic exenteration (operation range including radical cystectomy, partial urethrectomy rectectomy and partial vaginalectomy), and 8 cases with anterior pelvic exenteration operation (operation range including: radical cystectomy, part of urethrectomy and part of vaginalectomy). Of the 17 patients successfully completed the operation. The median operation time was 450 minutes (range 240-760 minutes), the median intraoperative blood loss was 2 200 ml (range 200- 8 400 ml), the median postoperative hospital stay was 17 days (range 9-55 days), the median hospital cost was 83 857 yuan (range 41 588-296 354 yuan). (3) Of the 17 patients underwent pelvic exenteration, 16 of them had early complications, the most common one was fever (14 cases). Fourteen of them had late complications, and the most common one was a urinary system infection (12 cases). (4) The median overall survival time was 26.0 months (range 3-44 months), the median progression-free survival (PFS) time was 9.0 months (range 2-44 months). Among them, 13 patients received radiation therapy during the initial treatment, the median PFS time was 9.0 months (range 2-30 months); 4 patients did not receive radiation therapy in the initial treatment, the median PFS time was 10.5 months (range 2-44 months).Eleven patients received adjuvant therapy after pelvic exenteration, the median PFS time was 12.0 months (range 2-44 months); 6 patients did not receive adjuvant therapy, the median PFS time was 5.0 months (range 2-9 months). Pelvic exenteration has a wide range of operations, many postoperative complications, and high hospitalization costs. Adjuvant treatment after pelvic exenteration could improve the PFS time for some patients. Its clinical value and health economic value need to be further explored.

摘要

探讨局部复发性宫颈癌患者行盆腔廓清术的围手术期情况及近期疗效。回顾性分析2015年10月至2018年5月在北京大学人民医院接受盆腔廓清术的17例局部复发性宫颈癌患者的临床病理特征、手术情况、住院费用、术后并发症及生存情况。(1)17例局部复发性宫颈癌患者的中位年龄为51岁(范围27 - 64岁)。病理类型:鳞状细胞癌13例,腺癌2例,腺鳞癌2例。13例患者在初始治疗期间接受了放疗,4例患者未接受放疗。(2)17例局部复发性宫颈癌患者行盆腔廓清术,其中9例行全盆腔廓清术(手术范围包括根治性膀胱切除术、部分尿道切除术、直肠切除术及部分阴道切除术);8例行前盆腔廓清术(手术范围包括:根治性膀胱切除术、部分尿道切除术及部分阴道切除术)。17例患者均成功完成手术。中位手术时间为450分钟(范围240 - 760分钟),中位术中出血量为2200 ml(范围200 - 8400 ml),中位术后住院时间为17天(范围9 - 55天),中位住院费用为83857元(范围41588 - 296354元)。(3)17例行盆腔廓清术的患者中,16例发生早期并发症,最常见的是发热(14例)。14例发生晚期并发症,最常见的是泌尿系统感染(12例)。(4)中位总生存时间为26.0个月(范围3 - 44个月),中位无进展生存(PFS)时间为9.0个月(范围2 - 44个月)。其中,13例患者在初始治疗期间接受了放疗,中位PFS时间为9.0个月(范围2 - 30个月);4例患者在初始治疗期间未接受放疗,中位PFS时间为10.5个月(范围2 - 44个月)。11例患者在盆腔廓清术后接受了辅助治疗,中位PFS时间为12.0个月(范围2 - 44个月);6例患者未接受辅助治疗,中位PFS时间为5.0个月(范围2 - 9个月)。盆腔廓清术手术范围广,术后并发症多,住院费用高。盆腔廓清术后辅助治疗可使部分患者的PFS时间延长。其临床价值及卫生经济学价值有待进一步探索。

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