Sall S, Pineda A A, Calanog A, Heller P, Greenberg H
Am J Obstet Gynecol. 1979 Oct 15;135(4):442-6. doi: 10.1016/0002-9378(79)90427-7.
From 1963 to 1977, 349 radical abdominal hysterectomies with bilateral pelvic lymphadenectomy were performed for Stage IB (331 patients) and Stage IIA (18 patients) cervical cancer at the New York Medical College, with no operative deaths. Definitive diagnosis was obtained from the biopsy specimen in 281 patients. Twenty-nine patients were pregnant when the diagnosis was established. The average operating time was 4 hours and 48 minutes with an average blood loss of 900 ml. Eleven fistulas were noted: ureterovaginal, 7; vesicovaginal, 3; rectovaginal, 1. Since 1972, there have been no fistulas in 130 radical hysterectomies. Metastatic carcinoma of the regional lymph nodes was discovered in 27 patients for an incidence of 7.7%. Postoperative total pelvic external irradiation was utilized in 40 patients (27 with positive nodes, 10 with microscopic carcinoma in vascular channels, and an additional three patients with an inadequate vaginal extirpation margin). A total of 62% of those patients with poor prognostic criteria receiving postoperative irradiation are alive and well. Two hundred nineteen patients have been followed up for at least 5 years and the survival rate was 90%. Our data support the view that radical abdominal hysterectomy with bilateral pelvic lymphadenectomy is the treatment of choice for patients with Stages IB and IIA cervical cancer in the nonpregnant state, unless there are major medical contraindications.
1963年至1977年期间，纽约医学院对331例IB期和18例IIA期宫颈癌患者实施了349例根治性腹式子宫切除术并双侧盆腔淋巴结清扫术，无手术死亡病例。281例患者通过活检标本获得明确诊断。确诊时29例患者已怀孕。平均手术时间为4小时48分钟，平均失血量为900毫升。发现11例瘘管：输尿管阴道瘘7例；膀胱阴道瘘3例；直肠阴道瘘1例。自1972年以来，130例根治性子宫切除术中未出现瘘管。27例患者发现区域淋巴结转移癌，发生率为7.7%。40例患者术后接受了全盆腔外照射（27例淋巴结阳性，10例血管通道有微小癌，另外3例阴道切除边缘不足）。接受术后放疗的预后不良标准患者中，共有62%存活且状况良好。219例患者至少随访了5年，生存率为90%。我们的数据支持这样的观点，即对于非妊娠状态的IB期和IIA期宫颈癌患者，除非有重大医学禁忌证，根治性腹式子宫切除术并双侧盆腔淋巴结清扫术是首选治疗方法。
