意外发现的宫颈癌宫旁广泛切除和阴道上段切除术的临床分析

摘 要: 【目的】 总结因意外发现的宫颈癌接受宫旁广泛切除术和阴道上段切除术患者的临床病理特点?围手术期并发症以及预后?【方法】 回顾性分析中山大学孙逸仙纪念医院2005年1月至2013年7月因子宫切除术后意外发现的宫颈浸润癌选择行宫旁广泛切除术的13例患者的临床资料及随访结果?【结果】 13例患者平均年龄42.6岁?切除子宫的指征分别为CIN3 5例,功能失调性子宫出血3例,子宫脱垂2例,子宫肌瘤2例,子宫腺肌症1例?13例患者中鳞癌9例,腺癌4例;临床分期Ib1期9例,Ia2期4例;3例患者有肉眼可见病灶,病灶大小10~30 mm;在复核切除的子宫标本中有1例患者病灶浸润宫颈间质外1/2;10例无肉眼可见病灶的患者中浸润深度4~9 mm;4例患者LVSI阳性;两次手术间隔中位时间为20 d;手术平均时间242 min;术中平均出血量400 mL,术中输浓缩红细胞1例;术中损伤肠管1例?切除的组织术后病理结果13例患者均无病灶残留及宫旁组织浸润,仅1例患者出现淋巴结转移术后接受了同期放化疗?2例患者术后出现并发症,包括1例膀胱阴道瘘及 1例小肠低位梗阻?拔除尿管平均时间为16.7 d;第一次拔除尿管平均残余尿量125 mL;住院时间平均17.5 d?中位随访时间为53个月,1例患者(第10例)出现阴道残端复发? 【结论】 宫旁广泛切除术和阴道上段切除术的围手术期并发症发生率较高,预防意外发生的宫颈癌是关键?

Clinical Analysis with Occult Cervical Cancer that Underwent Radical Parametrectomy and Upper Vaginal Resection

Abstract:【Objetvie】 To analyze the clinical pathology characteristic, perioperative and prognosis of 13 patients with occult cervical cancers that underwent radical parametrectomy and locate the patients who had low parametrial metastasis risk, and seek appropriate surgical approach. 【Methods】 The clinical data of 13 cases with occult cervical cancers that underwent radical parametrectomy from January 2005 to July 2013 were analyzed retrospectively.【Results】 The average age of the patients were 42.6 years. The indications for hysterectomy were CIN3 in 5 cases, dysfunctional uterine bleeding in 3 cases, uterine prolapse in 2 cases, uterine myoma in 2 cases and adenomyosis.Nine patients were diagnosed with squamous?carcinoma while 4 patients are adenocarcinoma. There were 9 patients with stage IB1 diseases and 4 with stage IA2. Only one patient had deep stromal invasion. Three patients had visible lesions measured 10~30 mm. Ten patients had no visible lesions but a depth invasion from 4~9mm. Only 4 patients had LVSI.Four patients had grade1 disease, 7 patients had grade 2 disease and 2 patients had grade 3 disease.The median operation interval between the first time and second time was 20 days. The average time of the operation was 242min.The average blood loss was 400mL. Perioperative complications included intraoperative bowl injury, blood transfusion in one patient respectively. Postoperative pathological findings showed no residual disease and parametrium involvement. Only one patient had lymph nodes mestastasis. There were 2 postoperative complications included 1 vesico-vaginal fistula and 1 ileus. The average time of catheter removal was 16.7 days and the average residual urine volume was 125 mL. Only 1 patient accepted chemoradiotherapy because of positive lymph nodes. The median follow-up time was 53 months; One patient had vaginal stump recurrence. 【Conclusion】Occultcervical cancer is less common, but the perioperative complications of radical parametrectomyoccurred frequently. Prevention is the key point to occult cervical cancer.