Resbeut M, Cravello L, Hannoun-Lévi J M, Agostini A, Alzieu C, Cowen D
Département de radiothérapie, Institut Paoli-Calmettes, Marseille, France.
Cancer Radiother. 1998 May-Jun;2(3):266-71. doi: 10.1016/s1278-3218(98)80004-8.
In patients with early cervix carcinoma, both radiotherapy and surgery or combined modalities provide effective therapies. In the two last modalities, recommended surgery is radical hysterectomy. The purpose of this prospective study was to assess the value of a limited vaginal hysterectomy after brachytherapy in patients without any unfavorable prognostic factor.
Twenty-two patients (stage Ia2 with vascular invasion: three patients, stage Ib 1:19 patients) with 1 cm median maximal tumor size and with previous negative laparoscopic lymphadenectomy (median number of lymph nodes: 12) underwent a limited vaginal hysterectomy 6 weeks after utero-vaginal brachytherapy.
Two mild intra-operative complications were noted. Venous hemorrhage (100 mL) occurred in one patient during lymphadenectomy and another patient presented bladder injury during hysterectomy. These two complications were successfully controlled with no need for laparotomy. Only one late complication was observed: bladder grade G2 (b). With a 29 months follow-up (20-48 months), no recurrence was reported.
These results appear promising in patients with very early cervix carcinoma but remain to be confirmed on a larger scale.
对于早期宫颈癌患者，放射治疗、手术治疗或联合治疗均为有效的治疗方法。在后两种治疗方式中，推荐的手术方式为根治性子宫切除术。本前瞻性研究的目的是评估在无不良预后因素的患者中，近距离放疗后行有限阴道子宫切除术的价值。
22例患者（Ia2期伴血管浸润：3例；Ib1期：19例），肿瘤最大径中位数为1cm，既往腹腔镜下淋巴结清扫结果为阴性（淋巴结数量中位数为12个），在子宫阴道近距离放疗6周后接受了有限阴道子宫切除术。
术中出现2例轻度并发症。1例患者在淋巴结清扫时发生静脉出血（100ml），另1例患者在子宫切除术中出现膀胱损伤。这两种并发症均得到成功控制，无需开腹手术。仅观察到1例晚期并发症：膀胱G2（b）级。随访29个月（20 - 48个月），无复发报告。
这些结果对于极早期宫颈癌患者似乎很有前景，但仍有待更大规模的研究证实。
