原发性宫颈腺癌的诊疗分析

The diagnostic and treated analysis of primary cervical adenocarcinoma

目的 探讨原发性宫颈腺癌的临床特点,以提高对该病的临床诊断及治疗水平.方法 回顾性分析25例原发性宫颈腺癌患者的临床资料.结果 25例原发性宫颈腺癌患者年龄18～75（53.23±11.37）岁,绝经后20例（80％,20/25）.专科检查见宫颈外形欠规则,颈管肥厚、变硬、延长、增宽.巨检类型：糜烂型1例,菜花型2例,溃疡型17例,颈管型5例.22例行子宫广泛切除术,2例行子宫次广泛切除术,1例因广泛粘连、少量腹水而手术中止,仅行化疗.手术＋放疗11例,手术＋同步放化疗12例.5年生存率76％（19/25）,预后最差的是2例Ⅳ期患者,分别于就诊后3个月和术后9个月死亡.肿瘤最大径及国际妇产科联合会（FIGO）分期与预后有关（P＜0.05）,而年龄、巨检类型、病理类型、治疗方法与预后无关（P＞0.05）.结论 宫颈腺癌好发于绝经后妇女,宫颈外形欠规则、颈管肥厚、变硬、延长、增宽是常见体征.早期及肿瘤较小患者经手术为主的综合治疗5年生存率较高.肿瘤最大径＞4 cm、FIGO分期晚者预后较差.早期发现、早期诊断、早期治疗可提高5年生存率.

Objective T. explore the clinical features of primary cervical adenocarcinoma in order to improve the level of diagnosis and treatment. Methods The clinical data of 25 patients with primary cervical adenocareinoma were retrospectively analyzed. Results The age was 18 - 75 （53.23 ＋ 11.37 ） years old and 20 （80%, 20/25 ） patients was postmenopause. The gynecologic examination showed that cervical shape was irregular,cervical canals paehynsis,hardening,extension and widen. The gross type included 1 case of erosio lump type, 2 cases of fungating type, 17 cases of nodus and induration ulcer type,5 cases of cervical canals type. Twenty-two patients received extensive hysterectomy and 2 patients received sub-extensive excision, 1 patient was forbiddened and was only received chemical therapy for the abdominal extensively adhesions with little ascites. Twenty-three patients were performed surgery and extracorporeal irradiation or high to midst dose rate after loading program radiotherapy; twelve of them were performed chemoradiation, but eleven patients couldn＇ t tolerable the chemical side effects and only took radiotherapy.The 5-year survival rate was 76% （19/25）. The poorest prognostic patients were the stage IV women, which died after 3 months and 9 months respectively from first visit the doctor. The mass diameter and the early FIGO stage were correlated with prognosis （P 〈0.05）. But age, gross type, pathological type, treated methods had no correlation with prognosis （P 〉 0.05）. Conclusions Cervical adenocarcinoma would be predilection postmenopause female. The common signs include cervical shape irregular,cervical canals pachynsis, hardening,extension and widen. The 5-year survival rate of the patients who received operation combined modality therapy in early stage and with small mass size is higher. The prognosis would be poor relatively in late FIGO stage and mass diameter over 4 cm. So, early discovery, early diagnosis and early treatment would be the key ways to improve 5-year survival rate.