本文選題：宮頸腫瘤　切入點(diǎn)：淋巴結(jié)轉(zhuǎn)移　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：根治性子宮切除術(shù)(radical hysterectomy, RH)是治療早期宮頸癌的標(biāo)準(zhǔn)術(shù)式。傳統(tǒng)的根治性子宮切除術(shù)不能達(dá)到真正盆壁將側(cè)盆壁的淋巴結(jié)完全切除,對局部晚期宮頸癌的治療效果不佳。淋巴結(jié)轉(zhuǎn)移是宮頸癌患者預(yù)后的重要因素,盆腔局部復(fù)發(fā)是宮頸癌治療失敗的主要原因。因此,為了提高患者盆腔局控率和提高局部晚期宮頸癌患者的生存率、生活質(zhì)量,有學(xué)者提出切除范圍更廣的側(cè)向擴(kuò)大性宮旁組織切除術(shù)(laterally extended parametrectomy LEP)。本文分成二部分：1、側(cè)向擴(kuò)大性宮旁切除術(shù)治療宮頸癌的系統(tǒng)評價(jià)2、側(cè)向擴(kuò)大性宮旁切除術(shù)治療宮頸癌的技巧、可行性分析。臨床數(shù)據(jù)來自廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院婦瘤科 §1側(cè)向擴(kuò)大性宮旁切除術(shù)治療宮頸癌療效和安全性的系統(tǒng)評價(jià) 目的評價(jià)側(cè)向擴(kuò)大性宮旁切除術(shù)在宮頸癌手術(shù)治療中的療效和安全性。 方法檢索國內(nèi)外已公開發(fā)表關(guān)于側(cè)向?qū)m旁擴(kuò)大性切除治療宮頸癌的文獻(xiàn)進(jìn)行初步循證評價(jià)。探討側(cè)向擴(kuò)大性宮旁切除術(shù)的安全性及臨床價(jià)值。 結(jié)果3篇文獻(xiàn)(563例患者)符合納入標(biāo)準(zhǔn)。最常見的手術(shù)相關(guān)并發(fā)癥是術(shù)中大量失血、其次為輸尿管狹窄、術(shù)后出血、淋巴囊腫等。 結(jié)論側(cè)向擴(kuò)大性宮旁切除術(shù)治療宮頸癌是安全可行的,對宮頸癌患者的手術(shù)療效可觀,可為宮頸癌患者提供另一種手術(shù)方式的選擇。但本系統(tǒng)評價(jià)納入研究中無非隨機(jī)對照的回顧性研究,納入病例數(shù)較少,結(jié)局指標(biāo)僅由單個(gè)研究中心報(bào)道。因此,目前還無法得到以上結(jié)論的確切療效,尚需進(jìn)行更多高質(zhì)量和大樣本前瞻性隨機(jī)對照研究來進(jìn)一步驗(yàn)證。 §2側(cè)向擴(kuò)大性宮旁切除術(shù)治療宮頸癌的技巧、可行性分析 目的探討側(cè)向擴(kuò)大性宮旁切除術(shù)治療宮頸癌的手術(shù)技巧、可行性及其對宮旁盆腔側(cè)壁淋巴結(jié)締組織的切除的作用。 方法選擇我院從2012年11月至2014年3月期間FIGO分期為ⅠB～ⅡB宮頸癌患者13例,統(tǒng)計(jì)分析接受側(cè)向擴(kuò)大性宮旁切除術(shù)(LEP)治療的手術(shù)時(shí)間、術(shù)中出血量、近期術(shù)后并發(fā)癥及術(shù)后恢復(fù)情況。 結(jié)果13例患者均順利完成LEP手術(shù),手術(shù)完成時(shí)間為321.5(180—485)min,術(shù)中平均出血量738.5(300—1500)ml,共9例患者在術(shù)中、術(shù)后需要輸紅細(xì)胞,平均輸血量3.0(2—6)U；術(shù)后肛門排氣時(shí)間2.5(2—5)d,術(shù)后排便時(shí)間平均3.7(2—6)d,術(shù)后平均住院時(shí)間為22.0(14—32)d。 結(jié)論LEP術(shù)式在技術(shù)上安全可行,更大范圍切除盆側(cè)壁的淋巴結(jié)締組織,在手術(shù)并發(fā)癥可接受情況下對宮旁組織切除達(dá)到Ⅲ-Ⅳ型根治性子宮切除所不能達(dá)到的真盆壁切除范圍,該術(shù)式可為伴有盆腔淋巴結(jié)轉(zhuǎn)移早期或局部侵潤的中晚期宮頸癌患者提供另一種手術(shù)方式的選擇。
[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摟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.摟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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