中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

机器人手术系统在早期宫颈癌保留生育功能手术中的应用(附手术视频)

Application of robotic surgical system in fertility-sparing surgery for early stage cervical cancer (with surgical video)

作者:李玲霞,陈必良,刘淑娟,吕小慧,周福兴,谭明华

Vol. 5 No. 4 Aug. 2024 DOI: 10.12180/j.issn.2096-7721.2024.04.014 发布日期:2024-10-22
关键词:机器人辅助手术;宫颈癌;保留生育功能

作者简介:

目的:分析达芬奇机器人手术系统在早期宫颈癌保留生育功能手术中的临床应用效果。方法:回顾 性分析空军军医大学第一附属医院 2013 年 12 月—2021 年 12 月使用达芬奇机器人手术系统完成的 11 例保留生育 功能早期宫颈癌患者的临床资料,统计分析患者术后是否补充切除子宫、月经恢复情况、是否受孕、是否复发等。 结果:11 例患者至今均存活,未复发,2 例切除子宫,其余 9 例月经均正常,其中 2 例已成功受孕并足月分娩, 7 例尚未受孕;目前已求助辅助生殖技术者 3 例,领养子女者 1 例。结论:机器人手术系统应用于早期宫颈癌保留 生育功能手术安全、有效,为年轻需要保留生育功能的早期宫颈癌患者提供了新的选择,但其应用优势及妊娠结局 仍需长期多中心临床试验来验证。

Objective: To analyze the clinical application effect of Da Vinci robot-assisted fertility-sparing surgery for early stage cervical cancer. Methods: 11 cases of Da Vinci robot-assisted fertility-sparing surgery performed in the First Affiliated Hospital of the Air Force Military Medical University from December 2013 to December 2021 were retrospectively analyzed. Patients had hysterectomy after surgery or not and their menstrual recovery, pregnancy and recurrence rate were statistically analyzed. Results: All 11 patients survived and no recurrence was found so far. Among them, 2 patients had hysterectomy, and normal menstruation was found in the rest 9 patients. 2 patients were successfully conceived and delivered to term, while 7 patients had not yet conceived. At present, 3 patients have turned to assisted reproductive technology, and 1 patient adopted a child. Conclusion: The robotic surgical system is safe and effective in fertility-sparing surgery for patients with early stage cervical cancer, which provides a new option for young patients with early-stage cervical cancer who need fertility preservation. However, its application advantages and pregnancy outcomes should be confirmed by long-term multicenter clinical trials.

稿件信息

收稿日期:2022-08-30  录用日期:2023-09-12 

Received Date: 2022-08-30  Accepted Date: 2023-09-12 

基金项目:国家自然科学基金面上项目(81972440);西安市人民医院(西安市第四医院)科研孵化基金联合科研项目(LH-16) 

Foundation Item: National Natural Science Foundation of China (81972440); Joint Research Project of Scientific Research Incubation Fund of Xi’an People’s Hospital (Xi’an Fourth Hospital) (LH-16) 

通讯作者:陈必良,Email:cblxjh@fmmu.edu.cn 

Corresponding Author: CHEN Biliang, Email: cblxjh@fmmu.edu.cn 

引用格式:李玲霞,陈必良,刘淑娟,等 . 机器人手术系统在早期宫颈癌保留生育功能手术中的应用(附手术视频)[J]. 机器人外 科学杂志(中英文),2024,5(4):568-574. 

Citation: LI L X, CHEN B L, LIU S J, et al. Application of robotic surgical system in fertility-sparing surgery for early stage cervical cancer (with surgical video)[J]. Chinese Journal of Robotic Surgery, 2024, 5(4): 568-574.

参考文献

[1] Tokunga H, Watanabe Y, Niikura H, et al. Outcomes of abdominal radical trachelectomy: results of a multicenter prospective cohort study in a Tohoku Gynecologic Cancer Unit[J]. Int J Clin Oncol, 2015, 20(4): 776-780. 

[2] Kim C H, Abu-Rustum N R, Chi D S, et al. Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer[J]. Gynecol Oncol, 2012, 125(3): 585-588. 

[3] 中国抗癌协会妇科肿瘤专业委员会 . 早期子宫颈癌保留生育 功能中国专家共识 [J]. 中国实用妇科与产科杂志 , 2022, 38(6): 634-641. 

[4] Chuang L T, Lerner D L, Liu C S, et al. Fertility-sparing robotic assisted radical trachelectomy and bilateral pelvic lymphadenectomy in early-stage cervical cancer[J]. J Minim Invasive Gynecol, 2008, 15(6): 767-770. 

[5] Bentivegna E, Maulard A, Pautier P, et al. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature[J]. Fertil Steril, 2016, 106(5): 1195-1211.e5. 

[6] Wydra D, Sawicki S, Wojtylak S, et al. Sentinel node identification in cervical cancer patients undergoing transperitoneal radical hysterectomy: a study of 100 cases[J]. Int J Gynecol Cancer, 2006, 16(2): 649-654.

[7] Kadkhodayan S, Hasanzadeh M, Treglia G, et al. Sentinel node biopsy for lymph nodal staging of uterine cervix cancer: a systematic review and meta-analysis of the pertinent literature[J]. Eur J Surg Oncol, 2015, 41(1): 1-20. 

[8] 刘青 , 刘开江 . 前哨淋巴结检测技术在早期宫颈癌中的应用 [J]. 中国癌症防治杂志 , 2019, 11(3): 194-198. 

[9] Bhatla N, Aoki D, Sharma D N, et al. Cancer of the cervix uteri[J]. Int J Gynecol Obstet, 2018, 143(Suppl 2): 22-36. 

[10] Lennox G K, Covens A. Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer?[J]. Gynecol Oncol, 2017, 144(1): 16-20. 

[11] Rob L, Lukas R, Robova H, et al. Current status of sentinel lymph node mapping in the management of cervical cancer[J]. Expert Rev Anticancer Ther, 2013, 13(7): 861-870. 

[12] Buda A, Di Martino G, Vecchione F, et al. Optimizing strategies for sentinel lymph node mapping in early-stage cervical and endometrial cancer: comparison of real-time fluorescence with indocyanine green and methylene blue[J]. Int J Gynecol Cancer, 2015, 25(8): 1513-1518. 

[13] Ruscito I, Gasparri M L, Braicu E I, et al. Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes-a meta-analysis[J]. Ann Surg Oncol, 2016, 23(11): 3749-3756. 

[14] Buda A, Papadia A, Di Martino G, et al. Real-time fluorescent sentinel lymph node mapping with indocyanine green in women with previous conization undergoing laparoscopic surgery for early invasive cervical cancer: comparison with radiotracer±blue dye[J]. J Minim Invasive Gynecol, 2018, 25(3): 455-460. 

[15] Cormier B, Diaz J P, Shih K, et al. Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer[J]. Gynecol Oncol, 2011, 122(2): 275-280. 

[16] Kim S, Chung S, Azodi M, et al. Uterine artery-sparing minimally invasive radical trachelectomy: a case report and review of the literature[J]. J Minim Invasive Gynecol, 2019, 26(7): 1389-1395. 

[17] Escobar P F, Ramirez P T, Garcia Ocasio R E, et al. Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy[J]. Gynecol Oncol, 2016, 143(2): 357-361. 

[18] TANG J, LI J, WANG S P, et al. On what scale does it benefit the patients if uterine arteries were preserved during ART?[J]. Gynecol Oncol, 2014, 134(1): 154-159. 

[19] Šimják P, Cibula D, Pařízek A, et al. Management of pregnancy after fertility-sparing surgery for cervical cancer[J]. Acta Obstet Gynecol Scand, 2020, 99(7): 830-838. 

[20] Raju S K, Papadopoulos A J, Montalto S A, et al. Fertility-sparing surgery for early cervical cancer-approach to less radical surgery[J]. Int J Gynecol Cancer, 2012, 22(2): 311-317. 

[21] Kasuga Y, Miyakoshi K, Nishio H, et al. Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy: a retrospective analysis[J]. BJOG, 2017, 124(11): 1729-1735.

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