早期宫颈癌手术方式的新趋势

doi:10.12280/gjfckx.20200715

摘要/Abstract

摘要：

宫颈癌是女性最常见的恶性肿瘤之一,治疗方法主要包括手术治疗和放射治疗,化疗广泛应用于与手术、放疗配合的综合治疗和晚期复发性宫颈癌的治疗,其中早期宫颈癌常采用经开腹或微创路径的手术治疗。2018年公布的宫颈癌微创手术临床试验（LACC）结果,首次对早期宫颈癌微创手术的近期、远期治疗效果和肿瘤学风险提出质疑,认为宫颈癌微创手术的无病生存率及总生存率比开腹手术低,引起了全球从事妇科肿瘤的医师对早期宫颈癌手术方式的重新思考。由于缺乏大量可靠的临床证据支持,临床实践指南中仍然保留微创手术方式是宫颈癌的标准治疗途径。一起“开腹”与“微创”之争后,多项临床研究结果先后证明在根治性子宫切除术中,与开腹手术相比,微创手术方式与更高的复发率和死亡率及较低的生存率相关。因此,在最新临床指南中删除根治性子宫切除术的微创手术路径,推荐开腹手术为早期宫颈癌根治性子宫切除术的标准路径,为广大妇科医师指出早期宫颈癌手术治疗的新趋向。

关键词: 宫颈肿瘤, 子宫切除术, 腹腔镜检查, 气腹,人工, 存活率分析

Abstract:

Cervical cancer is one of the most common malignant tumors in women. The treatment methods mainly include surgery and radiotherapy. Chemotherapy is widely used in combination with surgery and radiotherapy and the treatment of advanced recurrent cervical cancer. Among them, early cervical cancer is often used surgical treatment via open or minimally invasive route. The results of the clinical trial of the Laparoscopic Approach to Cervical Cancer (LACC) published in 2018 first questioned the short-term and long-term therapeutic effects and oncological risks of minimally invasive surgery for early-stage cervical cancer. They believed that the disease-free survival rate and overall survival rate of minimally invasive surgery for cervical cancer were lower than those of open surgery, which caused the global gynecologists to rethink the surgical methods. Due to the lack of reliable clinical evidence, minimally invasive surgery is still the standard treatment for cervical cancer. After a dispute between "laparotomy" and "minimally invasive surgery", a number of clinical studies have proved that minimally invasive surgery has higher recurrence rate, mortality rate and lower survival rate than open surgery in radical hysterectomy. Therefore, to delete the minimally invasive surgery of radical hysterectomy in the latest clinical guidelines, recommend open surgery is the standard path of radical hysterectomy for early cervical cancer, and point out the new trends of surgical treatment for early cervical cancer for gynecologists.

Key words: Uterine cervical neoplasms, Hysterectomy, Laparoscopy, Pneumoperitoneum,artificial, Survival analysis

阿迪莱·阿力木, 韩莉莉, 迪丽娜尔·艾山江. 早期宫颈癌手术方式的新趋势[J]. 国际妇产科学杂志, 2021, 48(3): 333-336.

Adilai Alimu, HAN Li-li, Dilinaer Aishanjiang. New Trends in Surgical Methods of Early-Stage Cervical Cancer[J]. Journal of International Obstetrics and Gynecology, 2021, 48(3): 333-336.

参考文献 26

[1]	Allouch S, Malki A, Allouch A, et al. High-Risk HPV Oncoproteins and PD-1/PD-L1 Interplay in Human Cervical Cancer: Recent Evidence and Future Directions[J]. Front Oncol, 2020,10:914. doi: 10.3389/fonc.2020.00914. doi: 10.3389/fonc.2020.00914
[2]	Murillo R, Ordóñez-Reyes C. Human papillomavirus (HPV) vaccination: from clinical studies to immunization programs[J]. Int J Gynecol Cancer, 2019,29(8):1317-1326. doi: 10.1136/ijgc-2019-000582. doi: 10.1136/ijgc-2019-000582
[3]	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020,70(1):7-30. doi: 10.3322/caac.21590. doi: 10.3322/caac.21590
[4]	姜波玲, 卢媛. 宫颈癌HPV预防性疫苗的研究进展[J]. 国际妇产科学杂志, 2018,45(5):527-530. doi: 10.3969/j.issn.1674-1870.2018. 05.009. doi: 10.3969/j.issn.1674-1870.2018. 05.009
[5]	中国抗癌协会妇科肿瘤专业委员会. 宫颈癌诊断与治疗指南(第四版)[J]. 中国实用妇科与产科杂志, 2018,34(6):613-622. doi: 10.19538/j.fk2018060111. doi: 10.19538/j.fk2018060111
[6]	舒锦, 周琦. FIGO2018子宫颈癌新分期变化与治疗的思考[J]. 中国实用妇科与产科杂志, 2019,35(12):1395-1400. doi: 10.19538/ j.fk2019120125. doi: 10.19538/ j.fk2019120125
[7]	Koh WJ, Abu-Rustum NR, Bean S, et al. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2019,17(1):64-84. doi: 10.6004/jnccn.2019.0001. doi: 10.6004/jnccn.2019.0001
[8]	Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri[J]. Int J Gynaecol Obstet, 2019,145(1):129-135. doi: 10.1002/ijgo.12749. doi: 10.1002/ijgo.12749
[9]	Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer[J]. N Engl J Med, 2018,379(20):1895-1904. doi: 10.1056/NEJMoa1806395. doi: 10.1056/NEJMoa1806395
[10]	Melamed A, Margul DJ, Chen L, et al. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer[J]. N Engl J Med, 2018,379(20):1905-1914. doi: 10.1056/NEJMoa1804923. doi: 10.1056/NEJMoa1804923
[11]	Odetto D, Puga MC, Saadi J, et al. Minimally invasive radical hysterectomy: an analysis of oncologic outcomes from Hospital Italiano (Argentina)[J]. Int J Gynecol Cancer, 2019,29(5):863-868. doi: 10.1136/ijgc-2019-000323. doi: 10.1136/ijgc-2019-000323
[12]	Kong TW, Chang SJ, Piao X, et al. Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer[J]. J Obstet Gynaecol Res, 2016,42(1):77-86. doi: 10.1111/jog.12840. doi: 10.1111/jog.12840
[13]	Guo C, Tang X, Meng Y, et al. Effect of the surgical approach on survival outcomes in patients undergoing radical hysterectomy for cervical cancer: A real-world multicenter study of a large Chinese cohort from 2006 to 2017[J]. Cancer Med, 2020,9(16):5908-5921. doi: 10.1002/cam4.3287. doi: 10.1002/cam4.3287
[14]	Nitecki R, Ramirez PT, Frumovitz M, et al. Survival After Minimally Invasive vs Open Radical Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-analysis[J]. JAMA Oncol, 2020,6(7):1019-1027. doi: 10.1001/jamaoncol.2020.1694. doi: 10.1001/jamaoncol.2020.1694 pmid: 32525511
[15]	Cusimano MC, Baxter NN, Gien LT, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer[J]. Am J Obstet Gynecol, 2019, 221(6):619.e1-619.e24. doi: 10.1016/j.ajog.2019.07.009. doi: 10.1016/j.ajog.2019.07.009
[16]	Abu-Rustum NR, Yashar CM, Bean S, et al. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020[J]. J Natl Compr Canc Netw, 2020,18(6):660-666. doi: 10.6004/jnccn.2020.0027. doi: 10.6004/jnccn.2020.0027 pmid: 32502976
[17]	王登凤, 张国楠. 从妇科肿瘤医生角度看子宫颈癌腹腔镜手术[J]. 中国实用妇科与产科杂志, 2020,36(4):313-317. doi: 10.19538/ j.fk2020040106. doi: 10.19538/ j.fk2020040106
[18]	董丹丹, 黄馨禾, 刘倩. 早期宫颈癌手术方式的研究进展[J]. 肿瘤学杂志, 2020,26(3):176-179. doi: 10.11735/j.issn.1671-170X.2020.03.B002. doi: 10.11735/j.issn.1671-170X.2020.03.B002
[19]	Obermair A, Asher R, Pareja R, et al. Incidence of adverse events in minimally invasive vs open radical hysterectomy in early cervical cancer: results of a randomized controlled trial[J]. Am J Obstet Gynecol, 2020, 222(3):249.e1-249.e10. doi: 10.1016/j.ajog.2019. 09.036. doi: 10.1016/j.ajog.2019. 09.036
[20]	Frumovitz M, Obermair A, Coleman RL, et al. Quality of life in patients with cervical cancer after open versus minimally invasive radical hysterectomy (LACC): a secondary outcome of a multicentre, randomised, open-label, phase 3, non-inferiority trial[J]. Lancet Oncol, 2020,21(6):851-860. doi: 10.1016/S1470-2045(20)30081-4. doi: 10.1016/S1470-2045(20)30081-4
[21]	Cao T, Feng Y, Huang Q, et al. Prognostic and Safety Roles in Laparoscopic Versus Abdominal Radical Hysterectomy in Cervical Cancer: A Meta-analysis[J]. J Laparoendosc Adv Surg Tech A, 2015,25(12):990-998. doi: 10.1089/lap.2015.0390. doi: 10.1089/lap.2015.0390
[22]	Wang YZ, Deng L, Xu HC, et al. Laparoscopy versus laparotomy for the management of early stage cervical cancer[J]. BMC Cancer, 2015,15:928. doi: 10.1186/s12885-015-1818-4. doi: 10.1186/s12885-015-1818-4
[23]	Shazly SA, Murad MH, Dowdy SC, et al. Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis[J]. Gynecol Oncol, 2015,138(2):457-471. doi: 10.1016/j.ygyno.2015.06.009. doi: 10.1016/j.ygyno.2015.06.009
[24]	余欣梅. 不同手术方式对宫颈癌根治术后疲劳综合征和免疫功能的影响[J]. 国际妇产科学杂志, 2017,44(5):512-515. doi: 10.3969/j.issn.1674-1870.2017.05.007. doi: 10.3969/j.issn.1674-1870.2017.05.007
[25]	王刚. 子宫颈癌临床决策要点——2019“NCCN子宫颈癌临床实践指南(第3版)”解读[J]. 实用妇产科杂志, 2019,35(3):180-184.
[26]	周晖, 刘昀昀, 罗铭, 等. 《2020NCCN子宫颈癌临床实践指南(第1版)》解读[J]. 中国实用妇科与产科杂志, 2020,36(2):131-138. doi: 10.19538/j.fk2020020111. doi: 10.19538/j.fk2020020111