气管切除术在下降:全国趋势,结果和学术成果跨越三个主要数据库
Gabriel Levin1, Lucy Gilbert1, Rene Pareja2
1Division of Gynecologic Oncology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
American journal of obstetrics and gynecology
|March 6, 2026
概括
宫癌的节育性手术显示,气管切除术和化术的存活率相似. 气管切除术的使用量有所下降,这表明在癌症治疗中转向了较不激进的外科手术方法.
科学领域:
- 妇科瘤学 妇科瘤学
- 手术瘤学手术瘤学
- 生殖医学 生殖医学
背景情况:
- 宫癌的节育手术 (FSS),包括化和简单的子宫切除术,在低风险病例中已经证明了安全性和低复发率.
- ConCerv研究 (2021) 提供了初步的前性证据,支持在精选的宫癌患者中支持FSS.
研究的目的:
- 调查两种宫癌FSS手术的时间趋势:气管切除术和化术.
- 分析与这些程序相关的瘤结果和学术生产力.
- 评价宫癌的年轻女性手术实践模式的变化.
主要方法:
- 三个数据库的回顾性分析:国家癌症数据库 (NCDB,2004-2022) 针对瘤结果,ACS-NSQIP (2012-2022) 针对外科手术后并发症,以及科学网络 (2000-2025) 针对文献计量.
- 鉴定了18-45岁的宫癌患者的队列,这些患者接受了气管切除术或结节分期的化.
- 通过程序计数和比例利用来检查时间趋势;通过卡普兰-梅尔和考克斯回归来分析生存率.
主要成果:
- 1,841名患者接受了FSS (911次气管切除术,930次结术);气管切除术患者年轻,检查了更多的淋巴结.
- 气管切除术显示,与化相比,状细胞癌的比例较低,腺癌的比例较高.
- 气管切除术的使用在2016年达到峰值,到2022年显著下降 (2011年的64.0%到2022年的33.3%).
- 气管切除术 (93.4%) 和化术 (92.3%) 组的十年整体存活率相似 (p=.39);气管切除术与存活率无关 (HR 1.02).
- 图书统计分析显示,有1585篇气管切除术的出版物,在2021年达到顶峰.
结论:
- 近年来,气管切除术的利用率显著下降,尽管形切除的瘤结果与形切除相似.
- 两个FSS组的高整体存活率支持了对宫癌的较少激进手术干预的趋势.
- 观察到的实践模式的转变凸显了在年轻女性中管理宫癌的不断变化的方法,优先考虑保护生育能力.
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