宫颈癌ⅠA1期的临床诊治进展分析

Analysis of diagnosis and treatment for cervical cancer of stageⅠA1

目的了解宫颈癌ⅠA1期的诊断和治疗手段在10年间的变化,探讨宫颈癌ⅠA1期有效并且安全的诊治方法。方法回顾性检索并复核了2005—2014年复旦大学附属妇产科医院收治的721例宫颈癌ⅠA1期患者的病史档案和随访资料,应用Pearsonχ2检验、确切概率法、Spearman相关分析,讨论10年间诊治方法的变化和效率。结果 721例宫颈癌ⅠA1期患者中,396例(54.9%)患者无症状,宫颈活检检出宫颈癌ⅠA1期患者82例(11.4%),宫颈锥切术检出640例(89.9%),检出率差异有统计学意义(P<0.01);2010—2014年较2005—2009年腹腔镜手术明显增加,经腹手术明显减少(P<0.01),根治性手术比例亦明显减少(P<0.01);35例失访,失访率为4.9%,随访期内复发1例,无死亡病例。结论宫颈锥切术有助于明确宫颈癌ⅠA1期的诊断;腹腔镜下全子宫切除术可以作为宫颈癌ⅠA1期的基本治疗手段。

Objective To evaluate the evolution of the effective and safe diagnostic and surgical approaches for patients with cervical cancer of stage Ⅰ A1 during ten years. Methods A retrospective cohort study of 721 cases diagnosed with cervical cancer of stage ⅠA1 from 2005 to 2014 was conducted by reviewing the archived medical records. Results Of patients with cervical cancer of stage ⅠA1,396 cases（54. 9%） had no symptoms and follow-up materials. The transformation of treatment and curative effect were evaluated with Pearson chi square test,Spearman correlation analysis as well as Fisher＇s exact probability.Pathology of biopsy clarified the diagnosis for 82 cases（11. 4%）,and pathologic results of conization made the definite diagnosis for 640 cases（89. 9%）（P 〈0. 01）. Laparoscopy grew to be the main trend of surgical approach for cervical cancer of stage ⅠA1 instead of laparotomy from 2010 to 2014 compared with 2005 to2009（P〈 0. 01）. Non-radical surgery became more popular to the cohort from 2010 to 2014（P〈 0. 01）.Thirty-five cases（4. 9%） were lost to follow-up. There was no dead case and a case of recurrence.Conclusions Conization was very important to clarify the diagnosis for cervical cancer of stage Ⅰ A1.Laparoscopic hysterectomy was a safe and effective treatment for cervical cancer of stage ⅠA1 patients.