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早期宫颈癌腹腔镜手术面临的挑战

向阳

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文章导航 > 协和医学杂志  > 2019 >  10(2): 100-102
向阳. 早期宫颈癌腹腔镜手术面临的挑战[J]. 协和医学杂志, 2019, 10(2): 100-102. doi: 10.3969/j.issn.1674-9081.2019.02.002
引用本文: 向阳. 早期宫颈癌腹腔镜手术面临的挑战[J]. 协和医学杂志, 2019, 10(2): 100-102. doi: 10.3969/j.issn.1674-9081.2019.02.002
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Yang XIANG. Challenge of Laparoscopic Surgery for Early-stage Cervical Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(2): 100-102. doi: 10.3969/j.issn.1674-9081.2019.02.002
Citation: Yang XIANG. Challenge of Laparoscopic Surgery for Early-stage Cervical Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(2): 100-102. doi: 10.3969/j.issn.1674-9081.2019.02.002
shu

早期宫颈癌腹腔镜手术面临的挑战

doi: 10.3969/j.issn.1674-9081.2019.02.002

  • 中国医学科学院 北京协和医学院 北京协和医院妇产科，北京 100730

基金项目: 

中国医学科学院医学与健康科技创新工程 2017-I2M-1-002

详细信息
    作者简介:

    向阳：电话：010-69155635，E-mail：xiangy@pumch.cn

  • 中图分类号: R713; R737.33

Challenge of Laparoscopic Surgery for Early-stage Cervical Cancer

  • Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要: 近年来，腹腔镜微创手术在早期宫颈癌中被广泛应用。既往回顾性研究显示，微创手术具有术中出血少、住院时间短、术后恢复快的优点，同时总生存期与传统开腹手术无差别。但N Engl J Med在2018年10月30日刊登的一项前瞻性多中心随机对照临床试验和一项回顾性流行病学研究结果均显示，微创手术增加了早期宫颈癌的死亡率。这两项研究结果虽不能完全否定腹腔镜在早期宫颈癌治疗中的作用，但应引起术者的重视与反思：规范化的肿瘤治疗原则是基础，手术路径的选择应以患者、疾病和术者技术特点为依据。
    Abstract: In recent years, minimally invasive laparoscopic surgery has been widely used in early-stage cervical cancer. Previous retrospective studies have shown that minimally invasive surgery is associated with less intraoperative blood loss, a shorter length of hospital stay, and a lower risk of postoperative complications than the abdominal approach, and yet does not affect survival. But a prospective multicenter randomized controlled clinical trial and a retrospective epidemiological study, which were published in the New England Journal of Medicine on October 30, 2018, showed that minimally invasive surgery in patients with cervical cancer was associated with a higher rate of recurrence and a lower rate of disease-free survival. We can't completely negate the role of laparoscopy in the treatment of cervical cancer. But these results cause our attention and reflection. The choice of the surgical path depends on the characteristics of the patient, disease and personal technology.
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    • 参考文献(13)
  • [1] Dargent D, Mathevet P.Radical laparoscopic vaginal hysterectomy[J]. J Gynecol Obstet Biol Reprod(Paris), 1992, 21:709-710. https://www.ncbi.nlm.nih.gov/pubmed/1430921
    [2] Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection[J]. Am J Obstet Gynecol, 1992, 166:864-865. doi:  10.1016/0002-9378(92)91351-A
    [3] Childers JM, Hatch KD, Tran AN, et al. Laparoscopic para-aortic lymphadenectomy in gynecologic malignancies[J]. Obstet Gynecol, 1993, 82:741-747. https://www.ncbi.nlm.nih.gov/pubmed/8414319
    [4] Querleu D.LeBlanc E. Laparoscopic infrarenal paraaortic lymph node dissection for restaging of carcinoma of the ovary or fallopian tube[J]. Cancer, 1994, 73:1467-1471. doi:  10.1002/1097-0142(19940301)73:5<1467::AID-CNCR2820730524>3.0.CO;2-B
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    [8] 向阳.腹腔镜在妇科肿瘤手术治疗中的应用历史与现状[J].中华妇产科杂志, 2015, 50:890-893. doi:  10.3760/cma.j.issn.0529-567x.2015.12.003
    [9] Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer[J]. N Engl J Med, 2018, 379:1895-1904. 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, 379:1905-1914. doi:  10.1056/NEJMoa1804923
    [11] Volz J, Koster S, Spacek Z, et al. The influence of pneumoperitoneum used in laparoscopic surgery on an intraabdominal tumor growth[J]. Cancer, 1999, 86:770-774. doi:  10.1002/(SICI)1097-0142(19990901)86:5<770::AID-CNCR11>3.0.CO;2-3
    [12] Lin F, Pan L, Li L, et al. Effects of a simulated CO2pneumoperitoneum environment on the proliferation, apoptosis, and metastasis of cervical cancer cells in vitro[J]. Med Sci Monit, 2014, 20:2497-2503. doi:  10.12659/MSM.891179
    [13] 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, 42:77-86. doi:  10.1111/jog.12840
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出版历程
  • 收稿日期:  2018-11-15
  • 刊出日期:  2020-09-18

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