补充广泛性手术治疗意外发现的宫颈浸润癌的效果

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摘要目的：探讨意外发现的宫颈浸润癌接受补充广泛性手术治疗患者的临床病理特点、围手术期并发症及预后。方法：收集2016年2月至2017年4月在温州医科大学附属第一医院住院的6例意外发现的宫颈癌并行补充广泛性手术患者的临床病理资料，并对其进行回顾性分析。各手术因素间的相关性分析采用Spearman相关性检验。结果：6例患者平均年龄（50.7±7.5）岁，子宫切除指征CIN III级2例，子宫平滑肌瘤1例，子宫腺肌病1例，宫颈癌Ia1期2例。6例意外发现的宫颈癌中鳞癌5例，腺癌1例；Ia1期1例，Ia2期2例，Ib1期3例，其中Ia1期的患者有脉管浸润。2次手术时间间隔为（23.8±13.9）d，手术时间为（176.0±77.9）min，术中出血为150（60，800）mL，盆腔淋巴结检出数为（24.5±6.6）个，留置尿管时间为（14.3±0.5）d，补充广泛性手术后住院时间为（10.0±2.4）d。1例患者术中出现膀胱损伤。1例患者有脉管浸润和盆腔淋巴结转移，术后予辅助放化疗。1例宫颈腺癌的患者，初次手术后肌层浸润4/5，术后予铂类为主的化疗。2次手术间隔时间和补充广泛性手术后留置导尿管时间呈正相关（r=0.840，P=0.036）。结论：补充广泛性手术难度大，围手术期并发症发生率低，对治疗意外发现的宫颈浸润癌是可行的。

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	余江涛
	郑飞云
	赵红琴

关键词 ：意外发现的宫颈浸润癌, 补充广泛性手术, 并发症

Abstract：Objective: To explore the clinical pathological features, perioperative complications and prognosis of accidental invasive cervical cancer treated by supplementary extensive surgery. Methods: Retrospective analysis of 6 patients with accidental invasive cervical cancer who accepted supplementary extensive surgery in the First Affiliated Hospital of Wenzhou Medical University from February 2016 to April 2017 and their clinical and pathological factors and prognostic factors were analyzed. The correlation between surgical factors were analyzed by Spearman correlation analysis. Results: The average age of these 6 patients was (50.7±7.5) years. Hysterectomy was carried out in 2 cases of CIN III, 1 case of uterus leiomyoma, 1 case of adenomyosis and 2 cases of cervical cancer in stage Ia1. Five of them had squamous carcinoma and 1 case of adenocarcinoma. There was 1 case in stage Ia1, 2 cases in stage Ia2, 3 cases in stage Ib1, in which patient in stage Ia1 had vascular infiltration. The interval time between the two operations was (23.8±13.9) d. The operative time was (176.0±77.9) min. Intraoperative bleeding was 150 (60, 800) mL. The number of pelvic lymph nodes was 24.5±6.6. The duration of indwelling catheter was (14.3±0.5) d. The time of hospitalization after supplementary extensive surgical was (10.0± 2.4) d. Bladder injury occurred in 1 patient. One patient had vascular infiltration and pelvic lymph node metastasis which was treated by postoperative adjuvant chemo-radiotherapy. One case of cervical adenocarcinoma with 4/5 muscular infiltration after initial operation, the postoperative chemotherapy was given based on platinum. There was significant correlation (r=0.840, P=0.036) between the interval time of the two operations and the time for indwelling catheter after supplementary extensive surgery. Conclusion: Supplementary extensive surgery is difficult but its perioperative complication rate is low and therefore it is feasible to treat the accidental invasive cervical cancer.

Key words： accidental invasive cervical cancer supplementary extensive surgery complication

收稿日期: 2017-08-05

通讯作者: 赵红琴，主任医师，Email：zhaohongqin2005@163.com。

作者简介: 余江涛（1980-），男，湖北孝昌人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I4/294

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