早期宫颈癌宫旁转移的低危因素及改良根治性子宫切除可行性分析

发布时间：2018-05-15 07:19

  本文选题：早期宫颈癌 + 改良根治术　； 参考：《复旦大学》2014年硕士论文

【摘要】：目的：探讨早期宫颈癌(IA1-IB1期)患者宫旁转移的低危因素,总结符合低危因素的患者行改良根治性子宫切除术的可行性。方法：回顾性分析2008～2011年间复旦大学附属妇产科医院收治的IA1-IB1期宫颈癌患者(共602例)行根治性子宫切除+盆腔淋巴结清扫术后,患者肿瘤大小、浸润深度、脉管内癌栓、切除范围(阴道壁长度、宫旁组织宽度)、部分免疫组化指标(CD31、D2-40、AE1/AE3)及预后生存情况,用统计学方法找到影响宫旁转移及生存结局的低危因素。结果：602名行根治性子宫切除+盆腔淋巴结清扫术的患者手术病理特点：中位年龄45岁,FIG0分期：IA1期36(6.0%),IA2期14例(2.3%),IBl期552例(91.7%),肿瘤直径≤2cm者354例(58.8%),浸润深度1/2肌层者371例(61.6%),脉管内未见癌栓(无脉管累及)者411例(68.3%),两侧宫旁组织切除宽度中位数3cm(两侧均大于等于3cm占42.9%),阴道壁切除长度中位数2.7cm,宫旁组织转移者23例(3.8%),盆腔淋巴结转移者69例(11.5%)。对以上数据进行Binary Logstic回归分析,结果显示病灶直径≤2cm、肌层浸润1/2、脉管内未见癌栓与宫颈癌宫旁转移间有显著意义(P0.05),为保护性因素(低危因素),同时符合3项低危因素的263例患者,宫旁转移率降为0.007%。602例患者随访12-60个月,27例死于宫颈癌。Cox生存模型分析,结果显示病灶直径≤2cm、肌层浸润1/2、脉管内未见癌栓对宫旁转移及生存结局的影响有显著意义(P0.05),为保护性因素(低危因素),宫旁组织切除宽度是否3cm对生存结局无显著影响(P0.05)。结论：肿瘤直径≤2cm,肌层浸润1/2,脉管内无癌栓是早期宫颈癌(IAI-IBI期)宫旁转移的低危因素,且宫旁组织切除宽度是否3cm对生存结局无显著影响,符合以上三项低危因素的患者有行改良根治性子宫切除术+盆腔淋巴结清扫术的可行性。
[Abstract]:Objective: to investigate the low risk factors of pariuterine metastasis in patients with early cervical cancer (stage I I I) and to summarize the feasibility of modified radical hysterectomy in patients with low risk factors. Methods: from 2008 to 2011, 602 patients (602 cases) with IA1-IB1 cervical cancer treated in Department of Obstetrics and Gynecology, Fudan University, underwent radical hysterectomy, pelvic lymph node dissection, tumor size, depth of invasion, intravascular cancer thrombus. The range of resection (length of vagina wall, width of para-uterine tissue, partial immunohistochemical index CD31D2-40AE1 / AE3) and survival status of prognosis were analyzed. The low risk factors influencing para-uterine metastasis and survival outcome were found by statistical method. Results the pathological features of 552 patients with radical hysterectomy and pelvic lymph node dissection were as follows: the median age was 45 years old and the median age was 45 years old. There were 14 patients with stage I 36 ~ 6.0D and 14 patients with stage I I ~ (2). 552 patients with stage I ~ (2) were treated with IBL. The diameter of tumor 鈮，

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