微创根治性子宫切除术以及避免早期宫颈癌癌细胞溢出的重要性：叙述性回顾

根治性子宫切除术是治疗早期宫颈癌的标准手术。 腹腔镜宫颈癌治疗 (LACC) 试验表明，接受微创根治性子宫切除术的患者比接受开腹根治性子宫切除术的患者预后较差； 然而，其原因仍不清楚。 LACC 试验有两个问题：学习曲线和程序效果。 为了正确解释手术随机对照试验的结果，需要对学习曲线效应（包括外科医生的技能）进行适当的管理。 根据外科医生的纳入标准和复发病例机构的分布，LACC 试验是否控制了学习曲线效应仍然存在争议。 还需要适当的手术程序，避免术中癌细胞溢出在癌症手术中起着重要作用。 治疗宫颈癌的微创手术期间癌细胞溢出是由多种因素引起的，包括 1) 肿瘤的暴露，2) 使用子宫操纵器，以及 3) 直接操作宫颈。 不幸的是，LACC 试验并未解决这些问题。 评估了微创根治性子宫切除术的结果，同时避免了早期宫颈癌的癌细胞溢出。 研究结果表明，在微创根治性子宫切除术中避免癌细胞溢出可以确保获得与开放根治性子宫切除术相当的肿瘤学结果。 因此，需要评估微创手术期间避免癌细胞溢出的重要性，并更好地控制学习曲线和手术效果。

微创根治性子宫切除术以及避免早期宫颈癌癌细胞溢出的重要性：叙述性回顾

图 1
使用无视无接触技术进行腹腔镜根治性子宫切除术。
(A) 阴道袖口创建。 在腹腔镜手术之前，制作了阴道套囊以避免癌细胞溢出到手术区域。 (B) 将标本装袋。 使用塑料袋通过阴道提取标本，以避免癌细胞溢出。 阴道套囊隐藏了图片中的肿瘤。

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