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目的:比较改良腹式广泛宫颈切除术(MART)与全腹腔镜广泛宫颈切除术(TLRT)在早期宫颈癌保留生育功能治疗中的技术异同性、临床治疗效果和妊娠结局。方法:收集2002年10月至2014年7月46例早期宫颈癌并接受MART或TLRT手术患者的临床资料和随访结果,并进行对比。结果:46例患者均完成预期手术,其中MART组27例,TLRT组19例。TLRT组术中出血量及住院时间明显少于MART组(P<0.05),MART组在手术时间、切除宫旁组织长度、子宫动脉损伤率方面明显优于TLRT组(P<0.05)。两组切除淋巴结数、腹腔引流量及膀胱功能障碍发生率等比较,差异无统计学意义(P>0.05)。术后随访两组均无复发,MART组妊娠率(38.10%)与TLRT组(53.85%)比较,差异无统计学意义(P>0.05)。结论:MART和TLRT两种手术方式均可有效治疗早期宫颈癌并实现患者保留生育功能的愿望。MART术式切除宫旁范围较TLRT相对较广,TLRT在减少术中出血及对盆腔脏器的干扰方面有其微创的优势。选择手术方式应个体化。
OBJECTIVE: To compare the technical differences, clinical outcomes and pregnancy outcomes between modified abdomino wide cervical resection (MART) and total laparoscopic extensive cervical excision (TLRT) in preserving reproductive function in patients with early stage cervical cancer. Methods: The clinical data and follow-up results of 46 patients with early cervical cancer undergoing MART or TLRT from October 2002 to July 2014 were collected and compared. RESULTS: All 46 patients underwent the prospective surgery, including 27 in the MART group and 19 in the TLRT group. The amount of bleeding and hospital stay in TLRT group was significantly less than that in MART group (P <0.05). MART group was significantly better than TLRT group in operation time, length of paravertebral tissue resection and uterine artery injury (P <0.05). There was no significant difference in the number of resected lymph nodes, abdominal drainage and incidence of bladder dysfunction between the two groups (P> 0.05). There was no recurrence after operation in both groups. The pregnancy rate (38.10%) in MART group was no significant difference compared with TLRT group (53.85%) (P> 0.05). Conclusion: Both MART and TLRT can effectively treat early cervical cancer and achieve the goal of retaining reproductive function in patients. MART resection of the uterine paratactic area is relatively wider than TLRT, TLRT in reducing the intraoperative bleeding and pelvic organ interference has its advantages of minimally invasive. Choose the surgical approach should be individualized.