45例复发性宫颈癌患者手术治疗的临床分析

Clinical Analysis of Surgery for Recurrent Cervical Cancer： A Review of 45 Cases

目的探讨复发性宫颈癌手术治疗的效果及预后影响因素。方法回顾性分析1980年1月至2015年10月间手术治疗的45例复发性宫颈癌患者的临床资料，分析其临床特点及预后。结果45例复发性宫颈癌患者的无复发间隔时间（RFI）为3～120个月，中位RFI为15个月。放疗野内复发21例，其中中心型复发18例，非中心型复发3例；非放疗野复发24例，其中盆腔复发（根治术后未行放疗）16例，远处复发8例。45例复发性宫颈癌患者复发后生存时间为（39.1±1.0）个月，2年生存率为55.6%，5年生存率为22.2%。单因素分析显示，临床分期、RFI、复发部位、初治方式与复发性宫颈癌患者的预后有关（均P〈0.05）。多因素分析显示，复发部位是影响复发性宫颈癌患者预后的独立因素（P＝0.047）。结论复发性宫颈癌患者的手术治疗应结合初治方式及复发部位进行选择。对于放疗野内中心型复发的患者，手术是有效的治疗手段。手术也适合于非放疗野孤立性复发的患者，联合辅助放化疗可以改善其生存情况。

Objective To study the efficacy of surgery for recurrent cervical cancer and the influencing factors on prognosis. Methods To retrospectively analyze the clinical data of 45 patients with recurrent cervical cancer undergoing surgical treatment in our hospital from January 1980 to October 2015, and study their clinical features and prognosis. Results The Recurrence Free Interval （RFI） of these 45 patients was 3-120 months, and their median RFI was 15 months. Of the 45 cases, 21 recurred inside the radiotherapy field, including 18 with central recurrence and 3 with non-central recurrence; and 24 recurred outside the radiotherapy field, including 16 with pelvic recurrence who did not receive radiotherapy and 8 with distant recurrence. The overall survival time after recurrence of these 45 cases was （39.1 ± 1.0） months, and their 2-year and 5-year survival rates were 55.6% and 22.2%, respectively. The univariate analysis showed that clinical stage, RFI, recurrent site, and initial treatment method affected the survival rate of the patients with recurrent cervical cancer （P〈0.05） , while the multivariate analysis revealed that recurrent site was an independent prognostic factor for recurrent cervical cancer （P = 0.047 ）. Conclusions Appropriate surgery should be chosen for recurrent cervical cancer according to initial treatment and recurrent site. For patients with central recurrence inside their radiotherapy field, surgery is an effective treatment. Surgery is also suitable for patients without previous radiotherapy and with isolated recurrence, and adjuvant radiotherapy and chemotherapy can improve their survival.