原发性输卵管癌21例临床分析

Clinical analysis of 21 patients with primany carcinoma of fallopian tube

目的:探讨原发性输卵管癌的临床特点、诊断及术后治疗.方法:将1994年1月1日～2004年1月1日收治的21例原发性输卵管癌患者的临床资料进行回顾性分析.结果:80.9%(17/21)的患者为绝经后妇女.原发性输卵管癌的主要临床表现为腹胀不适(9/21,42.8%)、阴道排液(8/21,38.1%)、不正常阴道流血(3/21,23.8%)、盆腔包块(15/21,71.4%)和腹水征(12/21,57.1%).术前彩超显示盆腔包块18例.术前CA125测定值＞35 U/mL占70.6%(12/17).术中见45.5%(10/21)的肿瘤位于右侧输卵管,54.5%(11/21)位于左侧输卵管;与周围组织无粘连的5例、明显粘连的16例.大网膜有转移结节或成饼状者7例.术后病理显示乳头型6例、乳头腺泡型7例、腺泡髓样型8例.FIGO分期:Ⅰ期2例、Ⅱ期5例、Ⅲ期12例、Ⅳ期2例.21例患者均接受手术及术后化疗.结论:原发性输卵管癌的临床表现不特异、术前诊断率低、预后差,血清CA125可作为原发性输卵管癌的标志物及术后化疗效果的评价指标.术后给予铂类为主的联合化疗对患者是有利的.

OBJECTIVE： To investigate the clinical feature, diagnosis and postoperative chemotherapy of primary carcinoma of fallopian tube. METHODS：The data of 21 patients with carcinoma of fallopian tuhe were analyzed retrospectively, and these patients were admitted to three hospitats from January 1,1994 to January 1, 2004. RESULTS： A toal of 80. 9% （ 17/21） of the patients were postmenopausal. The most common symptoms and signs were abdominal swelling and unease （9/21, 42. 8%）, abnormal watery discharge （8/21,38. 1%）, abnormal vaginal hleeding （3/21,23.8%）,a palpable pelvic mass （15/21,71.4%） and clinical suspicion of ascites （12/21, 57.1%）. The patients with preoperative serum CA125 〉 35 U mL was 70. 6%（12/17）. Operative findings showed the tumor were right in 10 patients （10/21,45. 5%） and left in 11（11/21,54. 5%）. The fallopian tube did not adhere to pelvic wall in 5 patients and the others had pelvic adhesion. The greater omentum was masslike in 7 patients. Postoperative pathology showed papilliferous carcinoma was in 6 patients, papillary-alveolar type in 7 and alveolar-medullary in 8. FIGO stages： 2 patients had Stage Ⅰ disease, 5 Stage Ⅱ 12 Stage Ⅲ and 2 Stage Ⅳ. All the patients received operation and postoperative chemotherapy. CONCLUSIONS： The symptoms and signs of primary adenocarcinoma of fallopian tube are not special and the preoperative diagnosis is rarely established. Its prognosis is poor. The serum CA125 level is a useful tumor marker in patients with fallopian tube carcinoma, and in patients who have elevated prechemotherapy serum CA125 level, this marker can safely be used as a surrogate marker for response and progression. After operation, the patients will benefit most from cisplatin based chemotherapy.