子宫颈浸润癌手术方式的选择

Choice of Surgery Type for Cervical Carcinoma

为了准确地选择宫颈浸润癌患者的手术范围 ,对 2 42例浸润癌患者的手术方式进行了探讨 ,其中 a期 19例、 b期 16 2例、 a期 16例、 b1 期 18例、放疗后未控或复发癌共 2 7例。 类手术 4例 ( a1 期 ) , 类手术 5例( a1 期 )、 类手术 10 4例、 类手术 12 5例、 类及 类手术各 2例。随访 5年。结果 : a、 b1 期 5年生存率均为 10 0 % , b2 期 5年生存率为 91.11% , b3期为 86 .11% , a及 b1 期 5年生存率分别为 81.2 5 %及 77.78% ,放疗后未控及复发癌的 5年生存率为 6 2 .2 3%。手术后主要并发症为泌尿道感染 ,膀胱功能障碍及输尿管瘘 ,其发生率随手术范围的扩大而增加。提示 :宫颈浸润癌手术方式的选择 ,应针对每个患者治疗的需要 ,选择一种合适的手术 ,既不盲目扩大手术范围 。

In order to choose the right surgery type for cervical carcinoma, 242 cases with cervical carcinoma treated by surgery are studied. There were 19 patients with stage Ⅰa, 162 patients with stage Ⅰb, 16 patients with stage Ⅱa,18 patients with stage Ⅱb, and 27 patients with recurrent carcinoma.4 patients were treated by surgery type Ⅰ, 5 patients by surgery type Ⅱ,104 patients by surgery type Ⅲ,125 patients by surgery type Ⅳ,2 patients by surgery typeⅤ and 2 patients by surgery type Ⅵ. All the patients were followed up at least for 5 years.It was apparent that patients with stage Ⅰa and Ⅰb 1 had a 5 year survival rate of 100 percent, whereas patients with stage Ⅰb 2、Ⅰb 3、Ⅱa and Ⅱb 1 had a 5 year survival rate of 91.11 percent, 86.11 percent, 81.25 percent and 77.78 percent respectively, 62.36 percent of the patients with recurrent carcinoma survived for five years.The main complications are infection of ureter, bladder dysfunction and fistula. It is important to understand that it is individual surgical expertise rather than the specific operative procedure that offers the highest cure rate and lowest incidence of complication to the patients with cervical carcinoma.