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目的:分析宫颈癌Ia1期年轻患者的临床病理特点、不同治疗方案的预后及对生活质量的影响,探讨其个体化治疗的安全性。方法:回顾分析2005至2014年复旦大学附属妇产科医院收治的286例年龄臆40岁的Ia1期宫颈癌患者的临床病例资料,结合手术前后病理结果,比较分析不同治疗方案的预后以及对生活质量的影响。结果:宫颈锥切或部分宫颈切除15例(5.2%),全子宫切除189例(66.1%),次广泛或广泛全子宫切除术+盆腔淋巴结清扫术82例(26.7%)。随访时间(3.76±0.44)年,复发1例,无患者死亡。各手术组的预后无显著差异。切缘阳性、切缘病变类型、LVSI阳性与残余病灶呈显著相关(P<0.05)。所有LEEP术后切缘阳性患者均行二次手术,其中6例保留子宫(3.9%),80例(52.6%)行全子宫切除术,66例(43.4%)行广泛/次广泛全子宫切除术+盆腔淋巴结清扫术。LVSI阳性共8例,其中1例保留子宫随访4年未复发。行广泛/次广泛全子宫切除术者无宫旁转移和淋巴结转移发生。与子宫切除术相比,广泛/次广泛全子宫切除术后患者生活质量明显下降,表现为下肢水肿、皮肤麻木、大小便困难、性生活障碍(P<0.01)。全子宫切除术后生活质量与保留生育功能者相比,无显著差异(P>0.05)。结论:对于无生育要求的宫颈癌Ia1期年轻患者,全子宫切除术安全有效并且有助于保护生活质量;对于有生育要求的患者,可行宫颈锥切,但需严密随访。
OBJECTIVE: To analyze the clinicopathological features, the prognosis of different treatment regimens and the quality of life in young patients with stage Ia1 cervical cancer and discuss the safety of individualized treatment. Methods: A retrospective analysis of 286 cases of Ia1 cervical cancer patients aged 40 years from 2005 to 2014 in Fudan University Obstetrics and Gynecology Hospital was conducted. The clinical data of patients with Ia1 cervical cancer were retrospectively analyzed. The prognosis of different treatment regimens were compared with those before and after surgery. Quality impact. Results: Cervical conization or partial cervical resection in 15 cases (5.2%), hysterectomy in 189 cases (66.1%), subtotal or extensive hysterectomy + pelvic lymph node dissection in 82 cases (26.7%). Follow-up time (3.76 ± 0.44) years, 1 case of recurrence, no patient died. The surgical group had no significant difference in prognosis. Positive margins and marginal lesions, LVSI positive and residual lesions were significantly correlated (P <0.05). All LEEP-positive patients underwent second surgery, of which 6 had retained the uterus (3.9%), 80 (52.6%) had hysterectomy and 66 (43.4%) had extensive / subtotal hysterectomy Surgery + pelvic lymph node dissection. A total of 8 cases of LVSI positive, including 1 case of retained uterus did not relapse 4 years follow-up. Extensive / Subtotal hysterectomy without paracancer and lymph node metastasis. Compared with hysterectomy, extensive / sub-total hysterectomy in patients with quality of life decreased significantly, manifested as lower extremity edema, skin numbness, difficulty in urinating, sexual dysfunction (P <0.01). There was no significant difference in quality of life after total hysterectomy compared with those who retained fertility (P> 0.05). CONCLUSIONS: Hysteroscopic hysterectomy is safe and effective for the protection of quality of life in young patients with stage Ia1 cervical cancer without fertility requirements. Cervical conization is recommended for patients with reproductive requirements but requires close follow-up.