CAJ | 학술논문

目的探讨宫颈腺鳞癌的临床特征、治疗模式及其对预后的影响.方法回顾性分析武汉大学中南医院2001年1月至2005年12月收治的21例宫颈腺鳞癌患者的临床资料.根据治疗方式的不同分为单纯手术治疗(6例)和综合治疗(15例),分析不同治疗模式对预后的影响.结果患者的中位年龄45岁,以未绝经患者(15例,占71%)为主;平均病程5.3个月(0.5～24.0个月),其中16例病程＜6个月;临床症状主要为阴道流血(17例,占81%).21例患者中,盆腔淋巴结转移7例(33%),卵巢转移3例(14%).21例患者的中位生存时间为54个月.其中,单纯手术治疗和综合治疗患者的中位生存时间分别为20、54个月,两者比较,差异无统计学意义(P＞0.05).12例Ⅰ b-Ⅱa期患者中,单纯手术治疗6例,综合治疗6例,其中位生存时间分别为20、66个月,两者比较,差异有统计学意义(P＜0.05).结论宫颈腺鳞癌具有病程短、进展快、预后差的特点,应采取综合治疗措施,术中保留卵巢需谨慎.
목적 탐토궁경선린암적림상특정、치료모식급기대예후적영향.방법 회고성분석무한대학중남의원2001년1월지2005년12월수치적21례궁경선린암환자적림상자료.근거치료방식적불동분위단순수술치료(6례)화종합치료(15례),분석불동치료모식대예후적영향.결과 환자적중위년령45세,이미절경환자(15례,점71%)위주;평균병정5.3개월(0.5～24.0개월),기중16례병정＜6개월;림상증상주요위음도류혈(17례,점81%).21례환자중,분강림파결전이7례(33%),란소전이3례(14%).21례환자적중위생존시간위54개월.기중,단순수술치료화종합치료환자적중위생존시간분별위20、54개월,량자비교,차이무통계학의의(P＞0.05).12례Ⅰ b-Ⅱa기환자중,단순수술치료6례,종합치료6례,기중위생존시간분별위20、66개월,량자비교,차이유통계학의의(P＜0.05).결론 궁경선린암구유병정단、진전쾌、예후차적특점,응채취종합치료조시,술중보류란소수근신.
Objective To explore the clinical diagnostic and therapeutic characteristics，prognostic factors of pailents with primary clear cell carcinoma of the cervix.Methods The clinical,pathologic and follow-up data of patients with primary clear cell carcinoma of the cervix treated in our hospital from Jan 2003 to Dec 2006 were collected and analyzed retrospectively.The relative literature was reviewed.Results Five patients with primary clear cell carcinoma of the cervix were treated(1 case stage Ⅰ b1，2 of stage Ⅰ b2，1of stage Ⅱ a，1 of stage Ⅳa).The mean age was 40.2 years(32 to 50 years).The primary symptom was mostly irregularly vaginal bleeding(3/5)and clinical type was predominantly(4/5)endophytie growth.The positive rate of cervical cytologic examination was 2/4,the negative rate of cervical human papillomavirus(HPV)DNA examination was 4/4.Serum CA125 level was abnormal(62.5 to 592.1 kU/L)before operation and when relapse occurred,and returned to normal after operation.All of five patients underwent operation,pathologic examination showed that three patients with infihration in deep 1/2 myomctrium of cervix,and two patients with infiltration in cervix-corpus juncture.Four patients underwent radical abdominal hysterectomy with systematic pelvic lymphadenectomy.All of four patients underwent four courses of chemotherapy with fluorouracil(5-FU)and carboplatin，one patient(stage Ⅱ a)was added with intracavitary brachytherapy.None of the four patients had relapse or metastasis after a follow-up of 10 to 44 months.The patient with stage Ⅳ a underwent firstly hysterectomy and prerectum mass removal.Pelvic relapse occurred three months after operation and the patient then underwent the second operation，external beam radiotherapy and intracavitary brachytherapy and 8 courses of chemotherapy with paclitaxel(taxol) and carboplatin.There was no relapse or metastasis after a follow-up of 26 months.Conclusions Primary clear cell carcinoma of the cervix may be unrelated to HPV infection.It shows predominantly endophytic growth and tends toward deep infiltration in cervix and extending to uterine corpus.Operation combined with chemotherapy with carboplatin and 5-FU or taxol may lead to relatively perfect short-term therapeutical effect.Serum CA125 can help to monitor prognosis.Objective To study the clinical characteristics，treatment modalities.and prognosis of cervical adenosquamous carcinoma.Methods The data of 21 patients with adenosquamous cervical cancer who were admitted into Zhongnan Hospital，Wuhan University from Jan 2001 to Dec 2005 were analyzed retrospectively.Six patients received Surgical therapy only and 15 patients received combined therapy.Results Seven cases were with positive pelvic lymph node metastases and 3 cases were with ovarian metastases.The median survival time of the combined therapy group and surgical therapy group was 54 and 20 months，respectively.In stage Ⅰ and stage Ⅱ patients，the median survival time of the combined therapy group and surgical therapy group was 66 and 20 months,respectively.The difference was significant between the two groups(P＜0.05).Conclusions Combined therapy should be given to patients with adenosquamous carcinoma of the cervix.Surgical therapy and chemotherapy play an important role in the management and prognosis of adenoquamous carcinoma of cervix.Preserve of ovary for patients with adenosquamous carcinoma of the cervix should only be done when the ovary is confirmed free from any malignant involvement by pathology.