Objective: To evaluate the security and clinical outcomes of open nerve-plane sparing radical hysterectomy (NPSRH) for operable locally advanced cervical cancer, compared with conventional radical hysterectomy (CRH). Methods: All 389 cases with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage Ⅰb2 and Ⅱa2 cervical cancer were retrospectively analyzed in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 2008 and December 2014. Of all the patients, 69 cases underwent laparotomic NPSRH, and other 320 cases underwent CRH. Patients' general characteristics and intraoperative parameters were evaluated between the two groups. Basic clinical and pathological informations between the two groups were matched. After median 82 months' follow-up,disease-free survival (DFS), overall survival (OS), and postoperative recovery of bladder function were compared between the two groups. Results: (1) Compared to CRH group, NPSRH group had less intraoperative bleeding [(366±302) vs (457±301) ml; t=2.305, P=0.022], and a little bit longer operation time [(262±51) vs (245±52) minutes; t=2.621, P=0.009]. (2) Compared to CRH group, NPSRH group had shorter duration of urethral catheterization [(11±9) vs (16±7) days; t=3.906, P<0.01], and better postoperative bladder sensation and function in one year (6.1% vs 16.0%; χ2=4.418, P=0.036). (3) The 5-year DFS rate and 5-year OS rate of all patients were 89.6% and 89.9%, respectively. Either preserving pelvic autonomic nerves or not had little effect on the 5-year DFS rate (NPSRH vs CRH: 90.9% vs 89.4%; P=0.714) or on 5-year OS rate (NPSRH vs CRH: 90.0% vs 89.9%; P=0.910) for locally advanced cervical cancer. Univariate analysis showed that lymphatic vascular space infiltration (LVSI) and pelvic lymphatic metastasis were significantly correlated with prognosis (P<0.05). Multivariate analysis showed that pelvic lymphatic metastasis was the independent prognostic factor of 5-year DFS rate (HR=1.31, 95%CI: 1.01-1.68, P=0.040) as well as 5-year OS rate (HR=1.30, 95%CI: 1.01-1.67, P=0.046) for locally advanced cervical cancer. Conclusion: Open NPSRH is feasible for patients with locally advanced cervical cancer, which could improve both short-term and long-term bladder function, and is not a risk factor for the prognosis of patients.
目的： 评价开腹保留盆腔自主神经平面的子宫广泛性切除术（NPSRH）治疗局部晚期（Ⅰb2和Ⅱa2期）子宫颈癌的安全性及有效性。 方法： 采用回顾性队列研究方法，收集2008年1月至2014年12月于中国医学科学院北京协和医学院肿瘤医院行开腹子宫颈癌根治性手术的局部晚期患者共389例，其中接受NPSRH 69例（NPSRH组），接受常规子宫广泛性切除术（CRH）320例（CRH组）。两组患者的基线临床病理指标分别比较均无显著差异（P>0.05）。中位随访时间为82个月（2~123个月），比较两组患者的手术相关指标、术后膀胱功能及预后，并分析预后影响因素。 结果： （1）手术相关指标：NPSRH组与CRH组比较，手术时间显著延长［分别为（262±51）、（245±52） min；t=2.621，P=0.009］，术中出血量显著减少［分别为（366±302）、（457±301） ml；t=2.305，P=0.022］；而两组患者的输血率、手术并发症发生率、住院时间分别比较，差异均无统计学意义（P>0.05）。（2）术后膀胱功能：NPSRH组与CRH组比较，术后导尿时间显著缩短［分别为（11±9）、（16±7） d；t=3.906，P<0.01］，远期膀胱功能障碍的发生率显著降低（分别为6.1%、16.0%；χ²=4.418，P=0.036）。（3）预后及其影响因素：389例局部晚期子宫颈癌患者的5年无病生存（DFS）率为89.6%，5年总生存（OS）率为89.9%；是否保留盆腔自主神经的局部晚期子宫颈癌患者的5年DFS率（分别为90.9%和89.4%，P=0.714）和5年OS率（分别为90.0%和89.9%，P=0.910）分别比较均无显著差异。单因素分析显示，淋巴脉管间隙浸润（LVSI）、盆腔淋巴结转移与局部晚期子宫颈癌患者的5年DFS率显著相关（P<0.05）；子宫颈间质浸润深度、LVSI、盆腔淋巴结转移与局部晚期子宫颈癌患者的5年OS率显著相关（P<0.05）。多因素分析显示，盆腔淋巴结转移是影响局部晚期子宫颈癌患者5年DFS率（HR=1.31，95%CI为1.01~1.68，P=0.040）和5年OS率（HR=1.30，95%CI为1.01~1.67，P=0.046）的独立危险因素。 结论： 开腹NPSRH治疗局部晚期子宫颈癌具有可行性，能改善患者近期及远期膀胱功能，且NPSRH并非影响患者预后的危险因素。.