摘要
目的探讨阴式子宫颈广泛性切除术(VRT)和腹式子宫颈广泛性切除术(ART)治疗早期子宫颈癌对生育功能及压力性尿失禁的影响。方法选取2014年1月至2015年1月间西安医学高等专科学校附属医院收治的行宫颈广泛性切除术的84例早期子宫颈癌患者,采用随机数字表法分为观察组和对照组,每组42例。观察组患者采用VRT治疗,对照组患者采用ART治疗,比较两组患者的手术指标、围手术期情况,术后随访5年内的复发情况及生育功能。结果观察组患者术中出血量、宫旁组织切除宽度、阴道切除长度、术后肛门排气时间及体温恢复正常时间均低于对照组,差异均有统计学意义(均P <0. 05)。两组患者手术时间、淋巴结切除数及宫颈切除长度指标比较,差异无统计学意义(P> 0. 05)。两组患者均发生感染、伤口愈合不良、肠梗阻及压力性尿失禁,观察组患者并发症总发生率(16. 7%)低于对照组(35. 7%),差异有统计学意义(P <0. 05)。术后随访5年,观察组患者复发1例(2. 4%),对照组复发6例(14. 3%);观察组患者有41例尝试生育,对照组有36例尝试生育,观察组患者妊娠率和分娩率分别为41. 5%和34. 1%,高于对照组的16. 7%和13. 9%,差异均有统计学意义(均P <0. 05)。结论相比ART治疗,采用VRT治疗早期宫颈癌患者有利于保留子宫体,提高治疗效果,降低压力性尿失禁等术后并发症发生风险,改善患者生育功能。
Objective To explore the effects of radical vaginal versus abdominal trachelectomy on reproductive function and stress urinary incontinence in early cervical cancer. Methods From January2014 to January 2015,84 patients with early cervical cancer who underwent trachelectomy at Xi’an Medical College Affiliated Hospital were selected. Using random number table method,patients were divided into an observation group and a control group with 42 patients in each group. The observation group underwent radical vaginal trachelectomy and the control group underwent abdominal radical trachelectomy. The surgical indicators,perioperative condition and the recurrence and reproductive function within 5 years of follow-up were compared the two groups. Results The intraoperative blood loss,width of excision of periuterine tissues,length of vaginal resection,time to postoperative anal exhaust and time to temperature recovery were significantly lower in the observation group than in the control group( all P < 0. 05). There was no significant difference in operative duration,number of lymph nodes that be dissected and length of cervical resected between the two groups( P > 0. 05). Wound infection,poor wound healing,intestinal obstruction,and stress urinary incontinence occurred in both groups. The overall incidence of complications was 16. 7% in the observation group which was lower than 35. 7% of the control group( P < 0. 05). Within 5 years of postoperative follow-up,1( 2. 4%) patient relapsed in the observation group and 6( 14. 3%) relapsed in the control group( P < 0. 05). Among them,41 patients were eager to have children in the observation group and 36 patients in the control group. The pregnancy rate and delivery rate( 41. 5% and 34. 1%) in the observation group were significantly higher than in the control group( 16. 7% and 13. 9%)( all P < 0. 05).Conclusion Compared with abdominal radical trachelectomy,the use of radical vaginal trachelectomy in the treatment of early cervical cancer is beneficial to preserve uterus as much as possible,improve the treatment effect,reduce the risk of postoperative complications such as stress urinary incontinence,and improve the reproductive function.
作者
王利娟
张英忠
宋艳艳
WANG Li-juan;ZHANG Ying-zhong;SONG Yan-yan(Department of Obstetrics and Gynecology,Xi'an Medical College Affiliated Hospital,Xi'an 710000,China;Department of Gynecology,Chang'an Hospital,Xi'an 710016,China)
出处
《中国肿瘤临床与康复》
2020年第7期793-796,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
