在全子宫切除术后标本中发现的浸润性宫颈癌30例临床分析

目的:探讨全子宫切除术后发现浸润性宫颈癌的原因及处理。方法:回顾分析1999年~2003年收治的全子宫切除术后浸润性宫颈癌病例的临床病理资料。结果:4年间收治浸润性宫颈癌6683例,全子宫切除术后发现30例,占0·4%。30例患者中15例(50%)初次手术前进行常规的宫颈细胞学检查,其中7例(46·7%)宫颈细胞学检查结果异常,12例行宫颈组织学检查,诊断为宫颈上皮内瘤变(cervicalintraepithelialneopla-sia,CIN)10例。初次手术主要指征为子宫肌瘤和子宫腺肌症(16例,53·3%),CINⅡ~Ⅲ(10例,33·3%),其它(4例13·3%)。24例术后行补救性放疗,4例行再次手术治疗,2例未行进一步治疗。随访6~67个月(平均36月),3年、5年生存率分别为68·25%、61·43%,Cox比例风险模型分析发现组织学类型是影响预后的独立因素(P=0·00)。结论:对宫颈癌筛查缺乏认识和对异常的宫颈刮片或活检结果处理不当是全子宫切除术后发现浸润性宫颈癌的主要原因,放疗是可行的补救性治疗措施。

Unexpected invasive cervical carcinoma found after hysterectomy:retrospective study of 30 cases

Objective:To explore the causes for inadvertent simple hysterectomy in the patients with cervical invasive carcinoma and the postoperative managements of these patients.Methods:The clinicopathological data of the patients with unexpected invasive cervical carcinoma found after simple hysterectomy treated from 1999 to 2003 were retrospectively analyzed.Results:During the 4 years,30 (0.4%) of 6683 patients with invasive cervical carcinoma were found after simple hysterectomy.Fifteen(50%)patients had preoperative papanicolaou smear,including 7(46.7%) abnormal results.Ten of 12 patients who had biopsy were diagnosed as cervical intraepithelial neplasia(CIN).The primary indications for simple hysterectomy included uterine leiomyomata or adenomyoma (16/30),CINⅡ~Ⅲ(10/30)and others (4/30).After primary operations,24 patients accepted salvage radiotherapy,4 patients accepted radical re-operations and 2 patients had no advanced therapy.Followed up 6 to 67 months (median observation time was 36 months),overall 3-year and 5-year survival rates were 68.25% and 61.43%.The Cox model showed that histological type was the only independent prognostic factor(P=0.00).Conclusion:This study confirms that the main reasons for inadvertent hysterectomy in patients with unexpected cervical invasive carcinoma are lack of attentions to cervical carcinoma screening and inappropriate management of abnormal cytology and biopsy.Radiotherapy is an acceptable salvage treatment.