宫颈微偏腺癌21例临床分析

目的探讨宫颈微偏腺癌（MDA）的临床特征、诊断、治疗及预后。方法对我院1985年1月至2008年1月收治的21例MDA患者的临床和病理资料进行回顾性分析。结果本组病例占同期宫颈腺癌治疗患者的4．O％。临床主要特征为水样或黏液样白带（61．9％）和不规则阴道出血（42．9％）。治疗前仅5例（23．8％）初次宫颈活检诊断出MDA。14例患者经过2～5次宫颈活检或锥切才最终确诊，确诊时间1—25个月（中位时间2个月）。临床分期：ⅠB期4例；ⅡA期2例，ⅡB。期5例；ⅢB期8例；外院治疔后无法分期者2例。11例ⅡB期以上者行根治性放化疗，全部肿瘤未控于7～26个月死亡；8例Ⅱ。期以下者行广泛性子宫切除术，有5例术后辅助放化疗，术后随访12～97个月，无一例死于本病；2例外院全宫双附件切除术后患者，1例阴道残端复发后行放疗肿瘤未控死亡，1例经补充手术及术后放疗无瘤生存。结论MDA常规活检诊断率低。早期患者应尽量采用根治性手术，对晚期患者实施放化疗效果差。及时确诊是治疗的关键。

Clinical analysis of 21 cases with minimal deviation adenocarcinoma of cervix

Objective To analyze the clinical characteristics, diagnosis, treatment and prognosis of cervical minimal deviation adenocarcinoma （MDA）. Methods A total of 21 patients with MDA from Jan 1985-Jan 2008 were analyzed retrospectively. Results The study group comprised 4. 0% of all the in-patients with cervical adenocarcinoma managed in the same period. The main symptoms were water-like or mueus-like leukorrhea （61.9%） and irregular vaginal bleeding （42. 9% ）. Only 5 cases （23.8%） were diagnosed as MDA by the first cervical biopsy, while 14 cases got the final definite diagnosis by biopsy for 2-5 times or conization of cervix, therefore treatment was delayed by 1-25 months （a median time of 2 months）.The clinical staging were 4 cases in stage ⅠB, 2 cases in stage ⅡA, 5 cases in stage ⅡB, 8 cases in stage ⅢB, and 2 cases could not be staged due to receiving treatment in other hospitals before. Eleven patients with stage-Ⅱ B or Ⅲ B MDA were treated with radical radio-chemotherapy, and all died of disease without tumor controlled. Eight cases with stage-ⅠB-ⅡB MDA were subjected to radical operation, and 5 of them received adjuvant radio-chemotherapy, all patients obtained disease-free survival. Two cases underwent hysterectomy in other hospital before, one of them with recurrent carcinoma was treated with radiotherapy, and died of the disease, the other one treated with salvage operation and adjuvant radiotherapy obtained disease-free survival. Conclusion MDA is difficult to diagnose by conventional biopsy. Radical hysterectomy should be the primary treatment for early-stage patients. Advanced-stage patients treated with radical radio-chemotherapy have poor prognosis. The critical measure for MDA treatment is making a definite diagnosis in time.