手术治疗早期颈癌508例临床资料分析

The Analysis of Clinical Data of Surgical Treatment of 508 Cases with Cervical Carcinoma

1970年～1988年手术治疗早期宫颈癌508例。Ⅰa．66例，Ⅱb。288例．Ⅱa95例，Ⅲb。59例。全部行根治性子宫切除和盆腔淋巴结清除术，其中17例因主动脉区淋巴结阳性行系统性清扫术。术前病灶直径2cm者行腔内1200cGy～2000cGy放射，淋巴结阳性者术后补充4000cGy～4500cGy体外放射，主动脉区阳性者加用化疗。全组共94例术前经过双足背淋巴管、盆腔、主动脉分淋巴结造影印染色，以提高术前淋巴结转移的诊断和增加术中淋巴清除率。全组5年存活率为91．9％。其中Ⅰa95．5％．Ⅰb。93．4％，Ⅱa90．5％，Ⅱb83．1％。淋巴结阳性组为71．4％，淋巴结阴性组为95．6％。讨论了它体转移者探查主动脉区并清除其阳性淋巴结的意义，输尿管外侧游离法在Ⅱb。或手术治疗中的价值，淋巴造影和淋巴染色提高阳性淋巴结清除率对预后的影响。

508 patients with cervical carciooma received surgical treatment from September 1970 to June 1988. Among these cases, 66 were in xtage 1., 288 were in stage Ⅱb, 95 were in stage Ⅱa and 59 were in stage Ⅱb according staging of FIGO(1985). The author per-formed radical hysterectomy with pevic lymphadenectomy for these patients. The metastatic lesions of 1 7 cases with periaortic nodal metastases were also dissected. The radiotherapy of 1200~2000o cGy given before tbe operation was performed. if tumor diameter was>2cm, 4000~4500 cGy given after tbe operation was performed,if the nodes were positive or stage Ⅱb confirmed by patbology. The chemotherapy was Per-formed when periaortic nodes were positive. The five years survival rate of 508 cases was 92. 0%. The 5 years survival rats of stage stage Ib stage Ⅱa and stage Ⅱb were 95. 5 %, 93. 4 %, 90. 5 % and 83. 1 % respectivey. The 5 years of sarvival rate of patiens with positive nodes was 71. 4%, and the rate of patients with negative nodes was 95. 6 %. The five years survival rate of 17 patients with periaortic positive nodes was 52. 9% (9/17 cases). In this article,the autbor confirmed the importance of exploring periaortic nodes and excising positive nodes as the any of uterus was invasived,the value of method of isolating ureter and in surgical treatment for stage Ⅱb,and the innuence of lymphan-giography and dyeing of lyrnphaden for the rate of nodal dissecting.