子宫颈癌全量放疗后局部肿瘤未控或中心型复发患者的手术治疗

目的 探讨宫颈癌全量放疗后局部肿瘤未控或中心型复发患者行手术治疗的可行性.方法 1972年3月至2008年1月间因宫颈癌全量放疗后局部肿瘤未控或中心型复发而行手术治疗的患者47例,其中行筋膜外子宫全切除术37例,行子宫广泛切除术7例,次广泛子宫切除术3例.结果 术后病理检查证实为局部肿瘤未控或中心型复发36例,临床诊断的符合率为76.6%(36/47).36例患者的中位生存时间为22个月,5年生存率为40.4%.其中行筋膜外子宫全切除术患者(29例)的中位生存时间为22个月,5年生存率为40.4%;行子宫广泛或次广泛切除术患者(7例)的中位生存时间为26个月,5年生存率为40.0%,两组5年生存率比较,差异均无统计学意义(均P=0.348).筋膜外子宫全切除术、子宫广泛或次广泛切除术患者的平均手术时间分别为2.5 h和3.8 h,出血量分别为272.1 ml和610.0 ml,手术并发症的发生率分别为21.6%和70.0%,差异均有统计学意义(P=0.007).结论 宫颈癌全量放疗后局部肿瘤未控或中心型复发患者行手术治疗,可使部分患者获得长期生存的机会.选择合适病例行筋膜外子宫全切除术是安全、有效的治疗方法.

Surgical intervention for the central recurrence or persistent local lesion of uterine cervical carcinoma following full-dose radiotherapy

Objective To evaluate the results of surgical treatment for central recurrence or persistent local lesion of uterine cervical carcinoma following full-dose radiotherapy. Methods Forty-seven patients were diagnosed having central recurrence or persistent local lesion of uterine cervical carcinoma following full-dose radiotherapy. The patients were treated surgically: extrafascial hysterectomy was performed in 37 cases, radical hysterectomy in 7, and modified radical hysterectomy in 3. Their clinicopathological features were retrospectively reviewed. Results Central recurrence or persistent local lesion was confirmed by pathology in 36 patients, while negative in 11. For patients receiving extrafascial hysterectomy, the median survival time and 5-year survival rate were 22 months and 40. 4% , while for radical hysterectomy corresponding figures were 26 months and 40. 0%. The mean operation time for the extrafascial hysterectomy and the radical or modified hysterectomy was 2.5 and 3. 8 hours, respectively. The mean blood loss was 272. 1 and 610. 0 ml, respectively. The postoperative mobidity was 21. 6% for extrafascial hysterectomy and 70.0% for radical or modified hysterectomy ( P = 0.007). Conclusion For some patients with central recurrence or persistent local lesion of uterine cervical carcinoma following fulldose radiotherapy, surgical intervention may achieve long time survival. Extrafascial hysterectomy is a feasible and effective treatment for some selected patients.