40岁以下妇女浸润性宫颈癌94例临床分析

Clinical analysis of 94 young patients with invasive cervical carcinoma aged 40 and younger

目的：探讨年轻妇女浸润性宫颈癌临床病理特征和治疗特点。方法：对2005年1月～2007年8月收治的40岁以下年轻浸润性宫颈癌患者94例的临床资料进行回顾性分析（研究组），并以同期治疗的41～73岁宫颈癌患者149例作为对照研究（对照组），分析两组的临床表现、病理特征和淋巴结转移情况及治疗特点。结果：40岁以下宫颈癌的比例高达38．68％，研究组初婚年龄、孕次、产次均较低（P〈0．01）。临床表现以接触性出血为主（P〈0．01），肿瘤类型以外生型为主（69．1％）。组织病理学类型及分级、淋巴结转移与对照组无显著性差异。临床分期以早期为主，Ⅰa～Ⅱa期共占76．5％（P〈0．01）。研究组94例中予以手术治疗75例，70例保留一侧或双侧卵巢并移位于同侧上腹部（P〈0．01），74例行盆腔淋巴结清扫，淋巴结转移率为18．92％，以闭孔淋巴结转移最常见。结论：宫颈癌有低年龄化趋势，应引起我们的高度重视。接触性阴道流血为年轻妇女宫颈癌的危险信号，应提高对年轻妇女宫颈癌的警惕性，治疗时应注意保留早期患者的卵巢功能。

Objective： To study the clinical characteristics, pathological characteristics and treatment of cervical carcinoma in younger women （≤40 years old） with invasive cervical carcinoma.Methods： The clinical information （clinical symptoms, pathological characteristics, metastasis of lymph nodes and treatments） of 94 younger women （ ≤40 years old） with invasive cervical carcinoma who were treated from January 2005 to August 2007 were retrospectively analyzed, in control with 149 over 40 years in the same period. Results： The percentage of invasive cervical carcinoma in young women increased to 38.68%. In the study group, the mean first marriage age, pregnancy and deliver times were lower （ P 〈 0. 01 ）. Compared with control group, the percentage of contact bleeding was higher in young women （ P 〈 0. 01 ） . The main type was outside. Clinical stage was main in early stage and the percentage of Ⅰ a - Ⅱ a was 76.5% （ P 〈 0. 01 ）. There were no significant differences between study group and control group in pathologic stage and grade, lymph node metastasis. 75 patients in study group were under operation while 70 of them were reserved one or two ovary and the ovaries were transplanted to the upper abdomen on the same side （P 〈0. 01） . The pelvic lymph nodes in 74 patients of young women were cleared. The rate of metastasis was 18. 92% and the obturator lymph nodes was the first place to be metastasized. Conclusion： The prevalence of the cervical carcinoma tends to be younger. Attention should be paid to young women. Contact bleeding is a dangerous signal of cervical carcinoma in young women. Ovarian function in patients with earlier stage should be kept during operation.