Tsunawaki A, Tanaka H, Yoh S, Yakushiji M, Kato T
Dept. of Obstetrics and Gynecology, Kurume University School of Medicine.
Gan To Kagaku Ryoho. 1988 Apr;15(4 Pt 2-1):903-8.
Cervical carcinoma is usually treated by extensive total hysterectomy such as Okabayashi's procedure. However, since the introduction of the criteria for classification of stage Ia lesions in 1978 by the Registration Committee for Cervical Carcinoma of the Japan Association of Obstetrics and Gynecology, surgical procedures have been categorized in greater detail, and reduced operations have begun to be performed. Generally, simple hysterectomy is performed for stage 0 cervical carcinoma, and semi-extensive hysterectomy is indicated for stage Ia lesions. In this study, reduced operations were evaluated in 254 patients with stage 0 and 288 with stage Ia cervical carcinoma selected from 1,412 patients with cervical carcinoma treated at our department between 1976 and 1985. The time required for the operation was 90.8 +/- 34.8 min for simple, 126.7 +/- 36.5 min for semi-extensive, and 173.5 +/- 42.5 min for extensive hysterectomy. The volume of bleeding was 274.5 +/- 257.7 ml for simple, 545.4 +/- 758.2 ml for semi-extensive, and 805.7 +/- 441.6 ml for extensive hysterectomy. The frequency of blood transfusion increased with the increase in the extent of surgery, being 9.0, 22.9, and 61.8% for the respective operations. The incidence of postoperative complications (cystoplegia, renal disorders, fistula of the urinary tract, ileus and hepatitis) also increased to 12.4% for semi-extensive and 44.8% for extensive hysterectomy. Simple hysterectomy was sufficient for stage 0 lesions, and side effects associated with this operation were infrequent and mild. Curative conization was performed for 14 patients who expressed a desire to have babies, and no recurrence has been observed to date. Semi-extensive hysterectomy was performed in 77% of stage Ia patients, and extensive and simple operations were performed in 8.0% and 10.4%, respectively. Close histological evaluation and postoperative care were carried out, particularly for patients who underwent simple hysterectomy. All these patients are currently alive without signs of recurrence. Two patients received only curative conization due to their strong desire to have babies and are currently being followed up. Both of these patients showed small degrees of interstitial invasion of less than 2mm.
宫颈癌通常采用广泛全子宫切除术进行治疗，如冈林式手术。然而，自日本妇产科学会宫颈癌登记委员会于1978年引入Ia期病变分类标准以来，手术程序的分类更加细化，并且开始实施缩小手术。一般来说，0期宫颈癌行单纯子宫切除术，Ia期病变行次广泛子宫切除术。在本研究中，对1976年至1985年间在我科接受治疗的1412例宫颈癌患者中选取的254例0期患者和288例Ia期宫颈癌患者的缩小手术进行了评估。手术所需时间，单纯子宫切除术为90.8±34.8分钟，次广泛子宫切除术为126.7±36.5分钟，广泛子宫切除术为173.5±42.5分钟。出血量，单纯子宫切除术为274.5±257.7毫升，次广泛子宫切除术为545.4±758.2毫升，广泛子宫切除术为805.7±441.6毫升。输血频率随手术范围的增加而增加，各手术分别为9.0%、22.9%和61.8%。术后并发症（膀胱麻痹、肾脏疾病、泌尿道瘘、肠梗阻和肝炎）的发生率在次广泛子宫切除术中也增加到12.4%，在广泛子宫切除术中为44.8%。单纯子宫切除术对0期病变足够，且该手术相关的副作用很少且轻微。对14例有生育愿望的患者进行了根治性锥切术，迄今为止未观察到复发。77%的Ia期患者行次广泛子宫切除术，分别有8.0%和10.4%的患者行广泛手术和单纯手术。对患者进行了密切的组织学评估和术后护理，特别是对接受单纯子宫切除术的患者。所有这些患者目前均存活，无复发迹象。2例患者因强烈的生育愿望仅接受了根治性锥切术，目前正在随访中。这2例患者均显示间质浸润程度小于2mm。
