摘要
目的分析46例宫颈残端癌患者的临床资料,为宫颈残端癌的诊治提供帮助。方法对近10年来46例宫颈残端癌患者的临床资料及治疗方法进行回顾性分析。结果46例患者中HPV16型阳性16例,HPV18型阳性10例,HPV53型阳性4例,HPV阴性16例。对46例患者进行术后病理检查,结果显示,鳞癌40例(86.96%),腺癌6例(13.04%)。手术患者40例,手术平均时间(195.00±32.30)min,术中平均出血量(740.62±88.24)mL,术中膀胱损伤8例(20.00%),术中输尿管损伤2例,肠管损伤0例,术后尿潴留6例,尿路感染2例,淋巴囊肿8例,肠梗阻0例。放疗患者6例,行盆腔外照射加腔内后装,外照射剂量40~50 Gy,腔内后装剂量25 Gy,放疗后肿瘤均完全消退,均未发生肠瘘和膀胱瘘。46例患者5年生存率90.90%。结论宫颈残端癌治疗原则以手术和放疗为主,手术困难、术中泌尿系统损伤风险高。拟行子宫次全切除术的患者术前应行人乳头瘤病毒(HPV)检测、宫颈液基薄层细胞学检查(TCT),必要时进行阴道镜检查等,以排除宫颈病变,术后也要严密随诊宫颈情况。
Objective To improve the diagnosis and treatment of cervical stump cancer by analyzing clinical data.Methods Clinical data of 46 cases of cervical stump cancer treated in the past 10 years were retrospectively analyzed.Results Among 46 cases,there were 16 cases HPV16 positive,10 cases HPV18 positive,4 cases HPV53 positive,and 16 cases HPV negative.40 cases were square carcinoma(86.96%),and the other 6 cases were adenocarcinoma(13.04%).40 cases had taken surgery again.The average duration of surgery was(195.00±32.30)minutes.The average blood loss during the surgery were(740.62±88.24)mL.There were 8 cases of bladder damage during the surgery(20.00%),2 case of ureter damage,no bowel damage,6 cases of urinary retention after surgery,2 case of urinary infection,8 cases of lymphocystis,and there was no intestinal obstruction.Six cases were treated with pelvic external irradiation and intracavitary afterloading.The external irradiation dose was 40~50 Gy and the intracavitary afterloading dose was 25 Gy,the tumor completely subsided without intestinal fistula and bladder fistula.Totally 5-year survival rate was 90.90%.Conclusions Surgery and radiotherapy are the main therapeutic approach to cervical stump cancer.However the technical difficulty of surgery and risk of urinary system damage is high.It is necessary to perform Human papilloma virus(HPV)test,cervical thinprep cytologic test(TCT),even colposcopy examination before subtotal hysterectomy,and take regular follow-up to identify the cervical conditions.
作者
刘立峰
董雨林
金仙玉
LIU Lifeng;DONG Yulin;JIN Xianyu(Department of Gynecology and Obstetrics,Dalian Municipal Central Hospital,Dalian 116023,China)
出处
《中国医药指南》
2020年第22期4-6,共3页
Guide of China Medicine
