侧向扩大性宫旁切除术治疗宫颈癌的系统评价与可行性分析

发布时间：2018-04-09 18:16

  本文选题：宫颈肿瘤　切入点：淋巴结转移　出处：《广西医科大学》2014年硕士论文

【摘要】：根治性子宫切除术(radical hysterectomy, RH)是治疗早期宫颈癌的标准术式。传统的根治性子宫切除术不能达到真正盆壁将侧盆壁的淋巴结完全切除,对局部晚期宫颈癌的治疗效果不佳。淋巴结转移是宫颈癌患者预后的重要因素,盆腔局部复发是宫颈癌治疗失败的主要原因。因此,为了提高患者盆腔局控率和提高局部晚期宫颈癌患者的生存率、生活质量,有学者提出切除范围更广的侧向扩大性宫旁组织切除术(laterally extended parametrectomy LEP)。本文分成二部分：1、侧向扩大性宫旁切除术治疗宫颈癌的系统评价2、侧向扩大性宫旁切除术治疗宫颈癌的技巧、可行性分析。临床数据来自广西医科大学附属肿瘤医院妇瘤科 §1侧向扩大性宫旁切除术治疗宫颈癌疗效和安全性的系统评价 目的评价侧向扩大性宫旁切除术在宫颈癌手术治疗中的疗效和安全性。 方法检索国内外已公开发表关于侧向宫旁扩大性切除治疗宫颈癌的文献进行初步循证评价。探讨侧向扩大性宫旁切除术的安全性及临床价值。 结果3篇文献(563例患者)符合纳入标准。最常见的手术相关并发症是术中大量失血、其次为输尿管狭窄、术后出血、淋巴囊肿等。 结论侧向扩大性宫旁切除术治疗宫颈癌是安全可行的,对宫颈癌患者的手术疗效可观,可为宫颈癌患者提供另一种手术方式的选择。但本系统评价纳入研究中无非随机对照的回顾性研究,纳入病例数较少,结局指标仅由单个研究中心报道。因此,目前还无法得到以上结论的确切疗效,尚需进行更多高质量和大样本前瞻性随机对照研究来进一步验证。 §2侧向扩大性宫旁切除术治疗宫颈癌的技巧、可行性分析 目的探讨侧向扩大性宫旁切除术治疗宫颈癌的手术技巧、可行性及其对宫旁盆腔侧壁淋巴结缔组织的切除的作用。 方法选择我院从2012年11月至2014年3月期间FIGO分期为ⅠB～ⅡB宫颈癌患者13例,统计分析接受侧向扩大性宫旁切除术(LEP)治疗的手术时间、术中出血量、近期术后并发症及术后恢复情况。 结果13例患者均顺利完成LEP手术,手术完成时间为321.5(180—485)min,术中平均出血量738.5(300—1500)ml,共9例患者在术中、术后需要输红细胞,平均输血量3.0(2—6)U；术后肛门排气时间2.5(2—5)d,术后排便时间平均3.7(2—6)d,术后平均住院时间为22.0(14—32)d。 结论LEP术式在技术上安全可行,更大范围切除盆侧壁的淋巴结缔组织,在手术并发症可接受情况下对宫旁组织切除达到Ⅲ-Ⅳ型根治性子宫切除所不能达到的真盆壁切除范围,该术式可为伴有盆腔淋巴结转移早期或局部侵润的中晚期宫颈癌患者提供另一种手术方式的选择。
[Abstract]:Radical hysterectomy is the standard procedure for early cervical cancer.Traditional radical hysterectomy can not achieve the true pelvic wall lymph node resection of the lateral pelvic wall, the treatment of locally advanced cervical cancer is not good.Lymph node metastasis is an important prognostic factor in patients with cervical cancer. Local recurrence of pelvic cavity is the main reason for the failure of cervical cancer treatment.Therefore, in order to improve the pelvic local control rate and improve the survival rate and quality of life of patients with locally advanced cervical cancer, some scholars have proposed to remove lateral extended parametrectomy leppon.This paper is divided into two parts: 1, the systematic evaluation of lateral expanded paracervical excision for cervical cancer. 2. The technique and feasibility of lateral expanded paracervical excision for cervical cancer.Clinical data from Department of Gynecomatology, affiliated Cancer Hospital, Guangxi Medical University搂1 systematic evaluation of efficacy and safety of lateral extended para-uterine resection in the treatment of cervical cancerObjective to evaluate the efficacy and safety of lateral expanded para-uterine resection in the treatment of cervical cancer.Methods A preliminary evidence-based evaluation was conducted on the literature published at home and abroad on the treatment of cervical cancer by lateral paracentric excision.To explore the safety and clinical value of lateral extended para-uterine resection.Results 563 patients met the inclusion criteria in 3 articles.The most common operative complications were massive intraoperative blood loss, followed by ureteral stenosis, postoperative bleeding, lymphocyst and so on.Conclusion it is safe and feasible to treat cervical cancer with lateral expanded para-uterine resection, and it can provide a choice for cervical cancer patients.However, the systematic evaluation was not only a randomized controlled retrospective study, but the number of cases included was relatively small, and the outcome index was reported by a single research center.Therefore, it is not possible to obtain the exact effect of the above conclusions, and more high quality and large sample prospective randomized controlled studies are needed to further verify the results.搂2 technique of lateral extended para-uterine excision for cervical cancer: feasibility analysisObjective to explore the surgical technique and feasibility of lateral expanded paracentric excision for cervical cancer and its effect on the resection of lymphoid connective tissue of paracervical pelvic wall.Methods from November 2012 to March 2014, 13 patients with 鈪，

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