宫颈残端癌12例临床分析

Clinical Analysis of Cervical Stump Cancer: Report of 12 Cases

目的探讨宫颈残端癌的临床特征、病理特点及治疗方法。方法回顾性分析我院2010年10月~2015年10月12例宫颈残端癌的临床资料。年龄41~62岁,(50.2±6.7)岁,子宫次全切除术后2~20年,(10.3±5.2)年,11例有阴道不规则流血或(和)排液,经宫颈活检确诊,其中鳞癌9例,腺癌2例,腺鳞癌1例。FIGO临床分期Ⅰ期6例,Ⅱ期6例。10例行广泛宫颈切除、双附件切除、盆腔淋巴结清扫术,其中ⅠA1期2例、ⅠB1期1例、ⅡA1期1例、ⅠB2期1例直接手术,ⅠB2期2例、ⅡA2期3例新辅助化疗后手术,术后除ⅠA1期2例外其余8例均补充放疗并化疗;ⅡB期2例中1例行同步放化疗,1例单纯化疗。结果 10例手术均获成功,术中大出血输血1例,输尿管损伤1例,术后尿管留置时间超过2周2例,髂血管区潴留囊肿1例。10例化疗、9例放疗中发生骨髓抑制4例,肝功能损伤1例,放射性膀胱炎1例,放射性直肠炎2例。12例随访时间7~74个月,中位数27.5月,无远处转移或死亡,3例盆腔局部未控和复发带瘤生存。结论宫颈残端癌的治疗原则以手术和放疗为主,化疗为辅,严格掌控子宫次全切除术手术指征及术后严密随访对宫颈残端癌的预防极其重要。

Objective To analyze the clinical and pathological characteristics of the cervical stump cancer and to explore its clinical therapy and prevention. Methods Clinical data of 12 cases of cervical stump cancer who were treated in our hospital between October 2010 and October 2015 were retrospectively analyzed. The patients were aged at 41-62 years old( mean,50. 2 ± 6. 7 years old) and underwent subtotal hysterectomy 2-20 years ago( mean,10. 3 ± 5. 2 years). Irregular vaginal bleeding and/or apocenosis occurred in 11 cases. All were diagnosed by cervical biopsy, finding 9 cases of squamous carcinoma,2 cases of adenocarcinoma and 1 case of adenosquamous carcinoma. FIGO stage distribution was stage Ⅰ in 6 cases and stage Ⅱ in 6 cases. Ten cases underwent colpo-cervicectomy and bilateral adnexectomy with lymphadenectomy,including direct surgical treatment in 2 cases of stage ⅠA1,1 case of ⅠB1,1 case of ⅡA1,and 1 of ⅠB2 and neoadjuvant chemotherapy before surgical treatment in 2 cases of stage Ⅰ B2 and 3 cases of Ⅱ A2. Except the 2 cases in stage Ⅰ A1,the other 8 cases received radiotherapy combined with chemotherapy after surgery. The 2 cases in stage Ⅱ B received full dose radiation and chemotherapy in one case and received chemotherapy in another. Results Ten cases of operation were successful,while intraoperative bleeding transfusion was required in1 case and ureteral injury occurred in 1 case. The postoperative indwelling time of catheter exceeded 2 weeks in 2 cases. Retention cyst of iliac vascular area was found in 1 case. Among the 10 chemotherapy and 9 radiotherapy cases,myelosuppression happened in 4cases,liver function injury was found in 1 case,radiocystitis occurred in 1 case,and radiation proctitis was noted in 2 cases. The 12 cases were followed up for 7-74 months( median,27. 5 months). No distant metastasis or death was seen. There were 3 cases of pelvic local control failure and tumor recurrence survival. Conclusions The treatment of cervical stump cancer is given priority to surgery and radiation therapy,and the chemotherapy is complementary. It is important to strictly master the indications of subtotal hysterectomy and emphasize on regular follow-ups after subtotal hysterectomy for preventing cervical stump cancer.