子宮根除手術，RH-I和RH-II兩型的技術差別和臨床意義

Radical hysterectomy : RH-I and RH-II descriptions and significance

台北榮民總醫院婦女醫學部（北榮婦醫），從1963-1999年以子宮根除手術(radical hysterectomy, RH)治療子宮頸癌FIGOIB-IIB病人有3,167例。我們將手術技巧，切除方式和重點都寫出來，報導我們的結果，作為治療的依據。RH可分為RH-I型和RH-II型兩類不同的手術方式。RH-II的重點是先分開覆蓋在輸尿管上的組織，再推開輸尿管將子宮膀胱韌帶整個的曝露出來，然後貼近膀胱，切斷子宮膀胱韌帶，以增加子宮頸旁組織和陰道旁組織的切除範圍，陰道的切除，則需離開陰道病灶1-2公分。切除標本包括整個子宮和附著子宮兩邊的子宮旁組織，子宮頸旁組織和陰道旁組織，切除邊緣週遭離子宮體，子宮頸和陰道各約1公分。沒有達到這個切除範圍，便是RH-I。意思是說，RH-I雖然也同樣的分開覆蓋在輸尿管上的組織，在推開輸尿管後，不需將子宮膀胱韌帶整個完全曝露出來，便沿著子宮將子宮膀胱韌帶切斷，行切除子宮的方式。這兩種RH手術方式，都必須同時行骨盆淋巴摘除。我們針對手術後的復發率發現，FIGOIB-IIA病人，無論是採取RH-I或採取RH-II，復發率分別是15.7%和13.3%(P>0.05)，無統計上的差別，這類病人，以RH-I方式處理便已足夠。FIGOIIB病人，RH-I或RH-II的手術後復發率分別為55.8%和29.9%(P<0.002)，有統計上意義，因此，FIGO IIB病人不適合用RH-I方式來處理。

Based on the retrospective study of 3,167 patients with cancer of the uterine cervix undergoing radical hysterectomy (RH), we have found the main routes of spread are commonly extended either into the parametrium or the paracervical tissues and paravaginal tissues and from there to the most commonly involved lymph nodes. With the RH we now offer, these tissues are adequately excised and the recurrence rate has been reduced from 55.8% to 29.9% (p<0.002), particularly in patients with stage IIB and above. In our institution , RH has been divided into two types: radical hysterectomy, type 1 (RH-I) and radical hysterectomy, type 2 (RH-II). In RH-II, the vesicouterine ligament needs to be completely exposed, divided and excised closed to the urinary bladder. Lateral excision not meeting this criteria is defined to RH-I. It is clear that these two types of RH depend on the extent of lateral excision. Our results indicated that RH-I is good for patients with IB-IIA and RH-II is good for patients with IIB and above.