Post-operative small pelvic field radiation therapy in patients with intermediate risk early stage cervix cancer: a safe and efficient treatment modality

BackgroundThe treatment of early stage cervical cancer has different therapeutic options. Adjuvant external beam radiotherapy for surgically treated intermediate risk cervical cancer patients has shown acceptable oncological outcomes with a low incidence of toxicity. The aim of this study was to analyze the oncological outcomes and safety of adjuvant small pelvic field radiotherapy in surgically treated stage IB1-2 cervical cancer patients who met the Sedlis intermediate-risk criteria.Materials and methodsA retrospective cohort study was carried out with 28 patients treated from 2007 to November 2019 with biopsy proven intermediate risk stage IB1–2 cervical cancer previously treated with radical hysterectomy and bilateral lymphadenectomy who received adjuvant small pelvic field radiotherapy. The primary endpoints were local and distant control and overall survival. Secondary endpoints were acute and late gastrointestinal and genitourinary toxicity. Survival curves were analyzed using the Kaplan-Meier method.ResultsAfter a median follow up period of 41.5 (27.5–80.5) months, adjuvant small pelvic field radiotherapy showed a 100% overall survival rate, 81.82% disease free survival and 86.36% local recurrence-free survival with no incidence of grade 3 or 4 acute or late toxicity. Three patients suffered from relapse, 1 in the vaginal cuff, 1 in the retrovesical area and 1 patient in the retroperitoneal area.ConclusionsAdjuvant small pelvic field radiotherapy is an efficient and safe treatment option that offers excellent oncological outcomes to surgically treated intermediate-risk stage IB1–2 cervical cancer patients with an excellent toxicity profile.     

Clinical Efficacy and Safety of Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review and Meta-Analysis

Backgroud and Objective

Nerve-sparing radical hysterectomy (NSRH) may be associated with lower postoperative morbidity than radical hysterectomy (RH). We aimed to compare the clinical efficacy and safety of abdominal or laparoscopic NSRH and RH for treating cervical cancer through systematic review and meta-analysis.

Methods

PubMed, EMBASE, The Cochrane Library and the Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to compare intra- and postoperative outcomes for the two techniques.

Results

A total of 17 clinical trials were identified. Meta-analysis showed that although operating time was significantly longer for abdominal or laparoscopic NSRH than for RH, NSRH based on laparotomy or laparoscopy proved more effective for postoperative recovery of bladder function. NSRH was also associated with lower bladder dysfunction morbidity and fewer postoperative complications. Two abdominal trials and one laparoscopic study further suggested that NSRH was associated with shorter time to recovery of anal/rectal function. In contrast, RH and NSRH based on laparotomy or laparoscopy were similar in terms of extent of resection, recurrence rate, survival rate, blood loss and frequency of intraoperative complications. The meta-analysis showed that abdominal NSRH was not significantly different from RH in length of hospital stay, while one trial suggested that length of hospital stay was shorter after laparoscopic NSRH than after the corresponding RH.

Conclusion

NSRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than RH for postoperative recovery of pelvic organ function and postoperative morbidity, while the two techniques involve similar clinical safety and extent of resection. These results should be considered preliminary since they are based on a relatively small number of controlled trials, most of which were non-randomized. The findings should be verified in larger, well-designed studies.     

Matched-Case Comparisons in a Single Institution to Determine Critical Points for Inexperienced Surgeons’ Successful Performances of Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Stage IA2-IIA Cervical Cancer

This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer.     

宫颈癌患者行根治性子宫切除术且保留盆腔自主神经的效果观察

目的:探讨宫颈癌患者行保留盆腔自主神经的根治性子宫切除术的临床效果。方法:按照随机数字表法将入选的48例宫颈癌患者随机分为对照组和试验组两组,每组患者各24例,其中对照组患者均采用传统的宫颈癌根治手术治疗,而试验组患者则采用保留盆腔自主神经的根治性子宫切除术进行治疗,比较两组患者的术中情况和术后恢复情况等。结果:两组患者的子宫切除出血量和术中总出血量以及术中输血率均无明显差异(均P0.05),但是试验组患者的子宫切除时间和手术总时间显著长于对照组患者(t=2.934,P0.05;t=3.121,P0.05)。两组患者之间的术后排气、排便时间均无明显差异(均P0.05),提示两组患者术后直肠功能无明显差异;对照组患者的术后残余尿量100ml时间与术后残余尿量50ml时间均显著高于试验组患者(t=2.891,P0.05;t=3.092,P0.05)。术后试验组患者的首次排尿感和急迫排尿感以及最大腹压等均显著低于对照组患者(t=4.283,P0.05;t=4.027,P0.05;t=3.137,P0.05);而最大膀胱压和最大尿流量以及最大逼尿肌压等则显著高于对照组(t=3.192,P0.05;t=2.938,P0.05;t=3.572,P0.05)。结论:采取保留盆腔自主神经的根治性子宫切除术能够较好地减少宫颈癌患者临床并发症的出现,具有较好的治疗效果,值得加以推广和运用。     

Hospitalization outcomes and racial disparities in cervical cancer patients: An analysis of the national inpatient sample data from 2002 to 2014

BackgroundLittle is known about outcomes in patients after being hospitalized for care of cancer or comorbid conditions and the disparity between African-American and White cervical cancer patients.MethodsUsing the national inpatient sample (HCUP-NIS) database of the Healthcare Cost and Utilization Project between 2002–2014, we included 5217 African-American and 21,752 White patients hospitalized with a primary diagnosis of cervical cancer. We examined racial differences in hospitalization outcomes; length of stay (LOS) in hospital, mortality in hospital, post-operative complications in patients who underwent hysterectomy and discharge disposition. Patients were matched on age at primary diagnosis, insurance status, residential region, and median income of residential area, modified Deyo comorbidity index, stage of disease and treatment. Categorical outcomes were analyzed by conditional logistic regression accounting for matched study design and odds ratios (95%CI) were reported. LOS was analyzed using t-test and beta estimate for difference in means was reported.ResultsThe LOS was significantly lower for Whites compared to African-American cervical cancer patients when matched on demographic only (β=-0.41, p-value<0.0005, presentation + demographic (β=-0.41, p-value<0.0006) and treatment + presentation + demographic variables (β=-0.46, p-value<0.0001). White cervical cancer patients were commonly discharged to other intermediate nursing facility (OR = 1.30, 95%CI = 1.20–1.41, matched on demographic only; OR = 1.31, 95%CI = 1.21–1.43, matched on presentation + demographic; and OR = 1.32, 95%CI = 1.22–1.43), matched on treatment + presentation + demographic). Similar trends were seen in both older (≥65 years) and younger (<65 years) patients, when stratified by age.ConclusionDisparities in hospitalization outcomes in cervical patients are not observed when different characteristics of African-American and White cervical patients are accounted for and matched.     

Incidence of radiation toxicity in cervical cancer and endometrial cancer patients treated with radiotherapy alone versus adjuvant radiotherapy

AimThe study was made to evaluate early and late toxicity in a diversified group of patients receiving definitive or adjuvant radiotherapy in terms of clinical diagnosis and treatment methods.BackgroundRadiotherapy is a standard way of treatment in cervical and endometrial cancer patients, both as definitive and adjuvant therapy. But every radiation treatment may be involved with toxicity.Materials and methodsA detailed analysis was performed of 263 patients with gynaecological cancer treated with definitive (90 patients with cervical cancer received radiochemotherapy or radiotherapy exclusively) and adjuvant radiotherapy (38 with cervical and 135 with endometrial cancer).ResultsAcute reactions were found in 51.3% and late reactions were found in 14.8% of patients. It was stated that early (p < 0.007) and late (p < 0.003) post radiation reaction appear more frequently in women treated with definitive than adjuvant radiotherapy. The analysis of the whole group revealed higher rate of toxicity, both early and late, in the gastrointestinal tract than in the urinary system (p < 0.004). Comparing the subgroups, it was found that intestinal reactions occurred more frequently in the definitive radiotherapy group than in the adjuvant one.The occurrence of side effects was associated with the prolongation of total irradiation time due to necessary interruptions of radiotherapy. The comparison of the subgroups showed that interruptions occurred more frequently in patients receiving definitive rather than adjuvant radiotherapy (17.7–2.9%).ConclusionsDefinitive radiotherapy compared with adjuvant treatment may by associated with higher percentage of side effects caused by dose of therapy and correlation with chemotherapy.     

Hysterectomy and risk of epithelial ovarian cancer by histologic type,endometriosis, and menopausal hormone therapy

BackgroundThis nationwide, register-based case-control study investigated the association between hysterectomy and risk of epithelial ovarian cancer according to histology and by history of endometriosis and menopausal hormone therapy (MHT) use.MethodsFrom the Danish Cancer Registry, all women registered with epithelial ovarian cancer at age 40–79 years during 1998–2016 were identified (n = 6738). Each case was sex- and age-matched to 15 population controls using risk-set sampling. Information on previous hysterectomy on benign indication and potential confounders was retrieved from nationwide registers. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer according to histology, endometriosis, and use of MHT.ResultsHysterectomy was not associated with risk of epithelial ovarian cancer overall (OR=0.99; 95% CI 0.91 –1.09) but was associated with reduced risk of clear cell ovarian cancer (OR=0.46; 95% CI 0.28–0.78). In stratified analyses, decreased ORs associated with hysterectomy were seen in women with endometriosis (OR=0.74; 95% CI 0.50–1.10) and in non-users of MHT (OR=0.87; 95% CI 0.76–1.01). In contrast, among long-term MHT users, hysterectomy was associated with increased odds for ovarian cancer (OR=1.20; 95% CI 1.03–1.39).ConclusionHysterectomy was not associated with epithelial ovarian cancer overall but with reduced risk of clear cell ovarian cancer. Our findings may suggest a reduced risk of ovarian cancer after hysterectomy in women with endometriosis and in MHT non-users. Interestingly our data pointed to an increased ovarian cancer risk associated with hysterectomy among long-term users of MHT.     

胃肠减压对胃癌患者远端胃切除术围手术期效果的影响

目的:探讨胃癌患者远端胃大部切除术后放置鼻胃管引流的短期效果。方法:选取我科从2010年9月1日到2013年3月1日间318例胃癌行远端胃切除的患者,随机分为术后留置鼻胃管(NGT组)或不留置组(no NGT组),比较两组间围手术期的短期效果。结果:158例患者纳入NGT组,而160例患者纳入no NGT组。两组间在术后腹胀、持续呕吐、吻合口瘘、发热、肺部感染、伤口感染的发生率上无统计学差异(P0.05)。进一步分析65例既往有腹部手术史的患者(NGT组34例vs no NGT组31例),NGT组腹胀发生率(5.88%vs 29.03%,P0.05)显著低于no NGT组。结论:对于胃癌患者行远端胃切除术后不推荐放置鼻胃管;而对于既往有腹部手术史的患者,术后放置胃管可以降低腹胀的发生。     

Meta-analysis of the clinicopathological characteristics and peri-operative outcomes of colorectal cancer in obese patients

BackgroundThe effect of obesity on the clinicopathological characteristics of colorectal cancer (CRC) has not been clearly characterized. This meta-analysis assesses the pathological and perioperative outcomes of obese patients undergoing surgical resection for CRC.MethodsMeta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for studies reporting outcomes for obese and non-obese patients undergoing primary CRC resection, based on body-mass index measurement. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI).ResultsA total of 2183 citations were reviewed; 29 studies comprising 56,293 patients were ultimately included in the analysis, with an obesity rate of 19.3%. Obese patients with colorectal cancer were more often female (OR 1.2, 95% CI 1.1–1.2, p < 0.001) but there was no difference in the proportion of rectal cancers, T4 tumours, tumour differentiation or margin positivity. Obese patients were significantly more likely to have lymph node metastases (OR 1.2, 95% CI 1.1–1.2, p < 0.001), have a lower nodal yield, were associated with a longer duration of surgery, more blood loss and conversions to open surgery (OR 2.6, 95% CI 1.6–4.0, p < 0.001) but with no difference in length of stay or post-operative mortality.ConclusionThis meta-analysis demonstrates that obese patients undergoing resection for CRC are more likely to have node positive disease, longer surgery and higher failure rates of minimally invasive approaches. The challenges of colorectal cancer resection in obese patients are emphasized.     

多西他赛或紫杉醇联合奈达铂在宫颈癌辅助化疗中的疗效及安全性分析

目的:观察和比较多西他赛或紫杉醇联合奈达铂辅助化疗治疗宫颈癌患者的临床疗效及其安全性。方法:选择45例采用多西他赛联合奈达铂化疗的宫颈癌患者为观察组及45例同期采用紫杉醇联合奈达铂化疗的宫颈癌患者作为对照组,两组均行手术治疗,且术前接受辅助化疗。对比两组临床疗效、手术时间和术后病理状况及不良反应的发生情况。结果:化疗后,观察组临床有效率高于对照组(62.22%vs.55.56%),但组间比较差异无统计学意义(P0.05)。化疗期间,观察组恶心、呕吐、腹痛、腹泻、白细胞、中性粒细胞减少、血红蛋白和血小板减少的发生率均低于对照组,但组间比较差异均无统计学意义(P0.05);观察组神经毒性发生率明显低于对照组,组间比较差异有统计学意义(P0.05)。化疗后,行手术治疗,观察组手术时间低于对照组,但组间比较差异无统计学意义(P0.05);手术后,观察组盆腔淋巴结转移率和宫旁浸润率低于对照组,但组间比较差异无统计学意义(P0.05)。结论:多西他赛联合奈达铂辅助化疗宫颈癌的疗效与紫杉醇联合奈达铂相当,且神经毒性、骨髓抑制方面的发生率明显降低,是临床低毒性且有效的宫颈癌术前新辅助化疗方案。     

Pathological and clinical outcomes of adrenalectomy: A multi-center experience in Saudi Arabia

ObjectiveTo determine the nature of adrenal pathology in patients undergoing adrenalectomy in Saudi Arabia over the last decade and compare it with the literature. We compared perioperative outcomes between minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA).MethodsThis retrospective study included patients who underwent adrenalectomy at five tertiary care centers in Saudi Arabia from 2010 to 2020. We collected patients’ baseline and perioperative characteristics and detailed hormonal evaluation of adrenal masses.ResultsAmong 160 patients (mean age 44 ± 14.5 years; mean BMI 29.17 ± 5.96 kg/m²), 84 (51.5 %) were men and 51.5 % had left-sided adrenal masses. The mean tumor size was 6.1 ± 4.2 (1.0–19.5) cm, including 60 (37.5 %) incidentalomas and 65 (40.6 %) functioning masses. Histopathology revealed 74 (46.2 %) adenomas and 24 (15 %) cancers or metastases from other primary organs; 20 %, 8.8 %, and 2.5 % of patients had pheochromocytoma, myelolipoma, and 2.5 % ganglioneuroblastoma, respectively. MIA and OA were performed in 135 (84.4 %) and 21 (15.6 %) patients, respectively. Adrenalectomy was increasingly performed over three equal periods in the last decade (17.5 % vs 34.4 % vs 48.1 %), with increasing numbers of MIAs to replace OAs. OA patients had larger tumors and needed blood transfusion more frequently (47.6 % vs 10.8 %, p< 0.001). MIA was significantly associated with shorter operative time, shorter length of stay, and less blood loss. Postoperative complications occurred in 10 (6.2 %) patients and were significantly higher for OA (24 % vs 3.0 %, p< 0.001).ConclusionsThe majority of adrenal masses are benign. Herein, the observed functional and perioperative outcomes were comparable to those of available meta-analyses.     

HGF和EZH2在宫颈癌组织中的表达及其与临床病理特征的关系

目的:探讨肝细胞生长因子(HGF)、果蝇zeste基因增强子2(EZH2)在宫颈癌组织中的表达及其与临床病理特征的关系。方法:选取2016年10月到2018年1月期间在新疆医科大学附属肿瘤医院接受治疗的宫颈癌患者50例,收集其手术切除的病理组织作为宫颈癌组的检测标本,另选取同期在我院收治的子宫肌瘤患者,收集其行全子宫切除术时切除的宫颈组织,其中上皮内瘤样病变(CIN)组织和正常宫颈组织各50例,CIN组织作为CIN组的检测标本,正常宫颈组织作为对照组的检测标本。比较宫颈癌组、CIN组和对照组标本中HGF和EZH2的阳性表达情况。分析HGF和EZH2的表达与宫颈癌患者临床病理特征的关系,分析宫颈癌组织中HGF、EZH2表达的相关性。结果:各组标本中的HGF和EZH2的阳性表达率整体比较差异均有统计学意义(P0.05),宫颈癌组、CIN组的HGF和EZH2的阳性表达率均明显高于对照组,且宫颈癌组EZH2的阳性表达率高于CIN组(P0.05)。宫颈癌组织中HGF和EZH2的表达与年龄、肿瘤类型、肿瘤大小无关(P0.05),临床分期II期、有淋巴结转移、病理分级G3的宫颈癌组织中HGF和EZH2的阳性表达率高于临床分期I期、无淋巴结转移、病理分级G1+G2的宫颈癌组织(P0.05)。经Spearman相关分析显示,宫颈癌组织中HGF与EZH2表达呈正相关(P0.05)。结论:HGF和EZH2在宫颈癌组织中呈高表达,且其表达水平与临床分期、淋巴结转移、病理分级有关。     

超声造影定量与动态增强MRI定量在宫颈癌诊断中的应用价值

摘要 目的：探究超声造影定量与动态增强MRI定量在宫颈癌诊断中的应用价值。方法：选择2016年1月至2019年1月于我院接受治疗的86例疑似宫颈癌患者为实验组,另选取同期于我院接受治疗的50例宫颈良性病变患者为对照组,分别对两组患者实施超声造影定量检测及动态增强MRI检查,对比两组患者各参数组间差异性,同时以病理学检测结果为金标准,分析两种检查手段对宫颈癌的筛查效果并实施组间比较。结果：（1）比较显示实验组患者的峰值强度（peak intensity,PI）及时间-曲线下面积（area under curve,AUC）均高于对照组,达峰时间（time to peak,TTP）及平均渡越时间（mean transit time,MTT）均低于对照组（P<0.05）;（2）比较显示实验组患者的容积转移常数（volume transfer constant,K ^trans ）、速率常数（rate constant,k _ep ）以及血管外细胞外容积分数（extravascular extracellular volume fraction,V _e ）均高于对照组,表观扩散系数（apparent diffusion coefficient,ADC）低于对照组（P<0.05）;（3）以病理学检测结果为金标准,超声造影定量检测对宫颈癌检测一致性为93.02 %,灵敏度为94.44 %,特异度为85.71 %,增强MRI对宫颈癌检测一致性为96.51%,灵敏度为98.61%,特异度为85.71%。结论：宫颈癌患者实施超声造影定量与增强MRI检测时检测参数与正常宫颈组织相比会出现明显的差异性,可将上述两种检测方式用于宫颈癌患者的筛查诊断中。     

Determinación rápida intraoperatoria de la paratirina intacta en la cirugía del hiperparatiroidismo primario. La experiencia en nuestro centro

IntroductionPrimary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT.Material and methodsRetrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012.ResultsIn the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients.ConclusionsDetermination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration.     

Thyroid Immune-Related Adverse Events in Patients with Cancer Treated with anti-PD1/anti-CTLA4 Immune Checkpoint Inhibitor Combination: Clinical Course and Outcomes

ObjectiveThyroid immune-related adverse events (irAEs) have been reported to have prognostic significance among patients with cancer treated with anti-programmed cell death-1 (PD1) and anti-programmed death-ligand 1 monotherapies. We evaluated the clinical course and predictors of thyroid irAEs in relation to outcomes of patients with advanced cancer treated with combination anti-PD1/anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4).MethodsWe conducted a regional study and identified patients with advanced cancer who received ≥1 cycle of combination anti-PD1/anti-CTLA4 between 2015 and 2019 in Hong Kong. Thyroid function tests (TFTs) were monitored every 3 weeks. Thyroid irAE was defined by ≥2 abnormal TFTs after initiation of combination anti-PD1/anti-CTLA4 in the absence of other causes.ResultsOne hundred and three patients were included (median age: 59 years; 71.8% men). About 45% had prior anti-PD1 exposure. Upon median follow-up of 6.8 months, 17 patients (16.5%) developed thyroid irAEs, where 6 initially presented with thyrotoxicosis (overt, n = 4; subclinical, n = 2) and 11 with hypothyroidism (overt, n = 2; subclinical, n = 9). Eventually, 10 patients (58.8%) required continuous thyroxine replacement. Systemic steroid was not required in all cases. Prior anti-PD1 exposure (odds ratio, 3.67; 95% CI, 1.19–11.4; P = .024) independently predicted thyroid irAEs. Multivariable Cox regression analysis revealed that occurrence of thyroid irAEs was independently associated with better overall survival (adjusted hazard ratio, 0.34; 95% CI, 0.17–0.71; P = .004).ConclusionThyroid irAEs are common in routine clinical practice among patients with advanced cancer treated with anti-PD1/anti-CTLA4 combination and might have potential prognostic significance. Regular TFT monitoring is advised for timely treatment of thyroid irAEs to prevent potential morbidities.     

中医多途径综合疗法治疗宫颈癌术后尿潴留的临床效果评价

目的:评价中医多途径综合疗法治疗宫颈癌术后尿潴留的临床效果和安全性。方法:选择2013年12月至2016年9月我院收治的60例宫颈癌术后出现尿潴留症状的患者,按其意愿将其分为对照组(30例)与研究组(30例),对照组接受水流声诱导、盆底肌锻炼等常规治疗方法,研究组在对照组基础上加以中医多途径综合疗法,比较两组治疗前后中医症状症状积分、自主排尿功能恢复时间、膀胱残余尿量、尿路感染率等情况。结果:治疗前,两组排尿无力、小腹坠胀、倦怠乏力、腰膝酸软积分比较差异均无统计学意义(P0.05);治疗后,两组以上指标均较治疗前明显降低,且研究组小腹胀痛、倦怠乏力积分均明显低于对照组,差异具有统计学意义(P0.05);研究组自主排尿功能恢复时间、膀胱残余尿量均明显低于对照组,差异具有统计学意义(P0.05);研究组尿路感染率为6.78%,明显低于对照组(23.33%),差异具有统计学意义(P0.05)。结论:中医多途径综合疗法治疗宫颈癌术后尿潴留的疗效肯定,可明显缩短病程,并降低尿路感染发生率。     

保留盆腔自主神经的宫颈癌根治术对Ib期宫颈癌患者性生活质量及膀胱直肠功能的影响

目的:探讨保留盆腔自主神经的宫颈癌根治术对Ib期宫颈癌患者性生活质量及膀胱直肠功能的影响。方法:选取我院于2010年1月~2017年1月期间收治的90例Ib期宫颈癌患者为研究对象,按乱数表法分为对照组和观察组,每组患者各45例。对照组患者采用传统的宫颈癌根治术治疗,观察组采用保留盆腔自主神经的宫颈癌根治术治疗。比较两组患者的手术情况、性生活质量以及膀胱直肠功能。结果:相比于对照组,观察组患者的手术时间较长,但住院时间较短(P0.05)。观察组术后残余尿量100 m L、50 m L的时间、肛门排气时间、排便时间与对照组比较均明显较短(P0.05)。术后观察组性生活质量各项评分低于对照组(P0.05)。观察组并发症发生率为6.67%,明显低于对照组的22.22%(P0.05)。结论:保留盆腔自主神经的宫颈癌根治术治疗Ib期宫颈癌患者临床疗效显著,有利于患者术后膀胱直肠功能的快速恢复,对患者的性生活质量影响较小,且术后并发症较少。     

腹腔镜下行子宫切除术及淋巴清扫术治疗老年子宫颈癌的疗效

目的:探讨腹腔镜与开腹下行子宫切除术及淋巴清扫术治疗老年子宫颈癌患者的临床疗效。方法:选取2014年1月至2016年1月我院收治的60例老年子宫颈癌患者,随机分为两组,每组30例,A组患者接受开放性子宫切除术及淋巴清扫术,B组患者在腹腔镜下行子宫切除术及淋巴清扫术,比较两组患者的手术情况、术后恢复情况以及术中、术后并发症的发生情况和随访期间的生活质量。结果:B组患者手术中淋巴结的清扫数目明显比A组多(P0.05),术中出血量和术后使用镇痛泵的次数明显少于A组(P0.05),抗生素的使用时间、术后排气时间、膀胱功能恢复时间、引流管滞留时间、住院时间较A组患者明显缩短(P0.05),术中大出血以及术后尿潴留、淋巴囊肿的发生率显著低于A组(P0.05);术后3个月和6个月的I-QOL以及FACT-G评分显著高于A组(P0.05)。结论:腹腔镜下行子宫切除术加盆腔淋巴清扫术治疗老年子宫颈癌患者的临床疗效显著,有利于患者术后恢复,并有效提高患者术后生活质量。     

Surgery versus radiotherapy: Long term outcomes of T1 glottic cancer

AimThe aim of this study was to compare the outcomes, patterns of failure and laryngeal preservation rates in patients with T1N0 glottic cancer treated with surgery or radiotherapy.Materials/methodsRetrospective study of T1N0 glottic cancer patients treated in our institution between January 2007 and December 2017. Histologically proven squamous cell carcinoma patients, treated with upfront cordectomy/partial laryngectomy (S group) or radiotherapy (RT group) were included. Elective treatment of the neck was not permitted. Local failure (LF), disease-free survival (DFS), ultimate disease-free survival (UDFS), laryngectomy-free survival (LFS), disease-specific mortality (DSM) and overall survival (OS) were evaluated.ResultsTwo hundred and one patients were eligible (172 S group, 29 RT group), with a median follow-up of 38.8 months. Overall, 33 (16%) patients had a recurrence, 30 (17%) in the S group and 3 (10%) in the RT group. Local failure was the predominant site of failure (28 S, 2 RT). Overall, of all those that were salvaged, 17 (8%) underwent total laryngectomy (15 S, 2 RT). There was no significant difference in the 5-year cumulative incidence of LF (20.8% S, 8.1% RT, p = 0.138), 5-y LFS (85.0% vs. 91.7%, p = 0.809), 5-y DFS (67.5% vs. 82.1%, p = 0.343), 5-y UDFS (82.5% vs. 90.3%, p = 0.647) and 5-y OS (84.5% vs. 90.3%, p = 0.892). Multivariate analysis showed no correlation between initial treatment and the analyzed outcomes.ConclusionPrimary surgery or radiotherapy were similar first line options, since they do not differ in all outcomes. Patients’ and physician's preferences must be considered when choosing first treatment.     

Laporovaginal surgery in cervical cancer: a Croatian experience

With correct staging a large number of patients with cervical cancer FIGO stages IA2 and IB can be spared of unnecessary radiation therapy by laparoscopic assisted vaginal radical hysterectomy (LAVRH) as an option of radical surgical treatment in such patients. The development of laparovaginal surgery, indication and contraindication were presented. Also, the surgical technique was described in detail. Fifty-two patients were followed up in 2003 after LAVRH or open surgery, performed in our single center. Only 5 (14%) patients died from cervical cancer within 3 years following the treatment. They were all clinical stage IB treated with open surgery. There were 4 (11%) complications following treatment and they were all in patients with clinical stage IB, also treated with open surgery. There was no complication in LAVRH treated patients. The results and complications of the sole Croatian center performing LAVRH or open surgery in patients with cervical cancer FIGO stages IA and IB were similar to those in centers across the world.