CAJ | 학술논문

目前对于宫颈腺癌的最佳治疗方案尚无定论。宫颈原位腺癌可采用全子宫切除、宫颈锥形切除或宫颈环形电切术（LEEP）。对ⅠA1期宫颈腺癌以往多采用广泛性子宫切除，现主张采用全子宫切除术，需保留生育功能的患者也可考虑宫颈锥形切除术。对ⅠA2～ⅡA期宫颈腺癌首选广泛性子宫切除+盆腔淋巴结清扫，有高危因素的患者需接受辅助性放化疗。对ⅡB～ⅣA期宫颈腺癌首选根治性放疗联合顺铂周疗的同步放化疗，紫杉醇联合顺铂可用于放疗前后的新辅助化疗及巩固化疗。ⅣB期宫颈腺癌宜采用个体化治疗，紫杉醇联合卡铂或吉西他滨联合顺铂均可使用。局部晚期或巨块型宫颈腺癌无论手术或放疗难度均大，新辅助化疗可以缩小肿瘤以利于手术或放疗，但能否改善生存尚有争议。对于难治性或复发性宫颈腺癌，可采用盆腔脏器廓清术、全盆腔放疗或铂类为基础的姑息性化疗。
목전대우궁경선암적최가치료방안상무정론。궁경원위선암가채용전자궁절제、궁경추형절제혹궁경배형전절술（LEEP）。대ⅠA1기궁경선암이왕다채용엄범성자궁절제，현주장채용전자궁절제술，수보류생육공능적환자야가고필궁경추형절제술。대ⅠA2～ⅡA기궁경선암수선엄범성자궁절제+분강림파결청소，유고위인소적환자수접수보조성방화료。대ⅡB～ⅣA기궁경선암수선근치성방료연합순박주료적동보방화료，자삼순연합순박가용우방료전후적신보조화료급공고화료。ⅣB기궁경선암의채용개체화치료，자삼순연합잡박혹길서타빈연합순박균가사용。국부만기혹거괴형궁경선암무론수술혹방료난도균대，신보조화료가이축소종류이리우수술혹방료，단능부개선생존상유쟁의。대우난치성혹복발성궁경선암，가채용분강장기곽청술、전분강방료혹박류위기출적고식성화료。
The optimal treatment pattern for cervical adenocarcinoma is still undefined. Patients with ceruical adenocarcinoma in situ often need a simple hysterectomy. But to young patients ,fertility-sparing surgeries such as cervical conization and LEEP are also options. To stageⅠA1 cervical adenocarcinoma,simple hysterectomy is much more used than radical hysterectomy now,but to young patients,cervical conization is also appropriate. The choice of treatment for most women with stage ⅠA2 to ⅡA disease is radical hysterectomy plus lymphedenectomy. Some patients require platinum based chemoradiation after surgery because of high-risk surgical-pathologic features. Primary radiation with weekly Cisplatin may be the best option for patients with stageⅡB toⅣA cervical adenocarcinoma. Furthermore ,Paclitaxel with Cisplatin can be used as neo-adjuvant chemotherapy before radiation or as consolidation chemotherapy following radiation. To choose a treatment forⅣB diseases is always difficult. Sometimes a palliative chemotherapy such as Paclitaxel plus Carboplatin or Gemcitabine plus Cisplatin is needed. Patients with local advanced or bulky diseases are difficult to deal with. Neo-adjuvant chemotherapy can be used to shrink the tumor. But whether it can prolong survival is still controversial. Management of relapsed or persistent diseases should be individualized,depending on the location of disease and the type of previous therapy. The treatment options including total pelvic exenteration,pelvic radiation and platinum based chemotherapy.