宫颈非鳞状细胞恶性肿瘤与宫颈鳞癌的临床病例分析
发布时间：2018-08-05 14:13
【摘要】：目的:宫颈癌是妇科医生最常遇见的恶性肿瘤之一。随着宫颈筛查在国内的普及,宫颈鳞癌在癌前病变阶段被检查出的几率增高,鳞癌的发病率有所降低,但宫颈非鳞癌早期的临床表现相对不典型,多在宫颈管内生长,同时宫颈腺癌进行细胞学筛查时,出现假阴性的比例较高,在癌前病变阶段不易被诊断,容易出现漏诊。导致发病率相对有所上升,尤其在年轻女性中。本研究通过对宫颈非鳞状细胞恶性肿瘤的临床病例进行分析,讨论宫颈非鳞状细胞恶性肿瘤(以下简称非鳞癌)的临床特征、诊断、卵巢转移情况及治疗和预后。为临床治疗提供指导。方法:对陆军总医院2010-01到2016-05月收治的35例宫颈非鳞癌患者与同期228例宫颈鳞癌患者的临床及病理资料进行回顾性分析。结果:1.非鳞癌患者占同期宫颈恶性肿瘤的13.3%。35例宫颈非鳞癌患者年龄25--76岁,平均年龄(50.7±13.3)岁。绝经前患者18例(51.4%),绝经后患者17例(48.6%)。35例宫颈非鳞癌中宫颈腺癌12例(34.3%),黏液腺癌9例(25.7%),腺鳞癌6例(17.1%),神经内分泌癌6例(17.1%),肉瘤样癌1例(2.9%),腺肉瘤1例(2.9%)。绝经前与绝经后非鳞癌发病的组织病理类型对比存在显著性差异(P0.05)。2.非鳞癌患者的临床表现阴道异常出血20例(57.1%),阴道水样或黏液样排液2例(5.7%),阴道排液伴有阴道出血10例(28.6%),无症状体检发现者3例(8.6%)。子宫颈局部表现:宫颈表面有外生型肿瘤、呈息肉状或菜花状21例,溃疡型6例,表面光滑者8例。宫颈非鳞癌组以阴道排液为主要症状就诊的比例为34.3%,而宫颈鳞癌组以该临床表现就诊的患者只有18.9%;非鳞癌组宫颈光滑无肉眼可见病灶占22.9%,而宫颈鳞癌组该表现的患者占9.3%,两组比较差异显著。I、II期非鳞癌患者盆腔淋巴结转移率为22.2%,同期别鳞癌出现盆腔淋巴结转移的为17.1%,两组比较差异无显著性(P0.05)。3.非鳞癌组宫颈细胞学检测:20例治疗前行宫颈细胞学检测,其中细胞学异常12例(60%),正常8例。15例患者行HPV检测,其中阳性者7例(47%),均为HPV高危亚型感染,其中5例为HPV16或(和)18型感染。4.非鳞癌患者中有7例保留卵巢,同期(IB期、II期)行手术治疗切除双侧卵巢的患者18例。非鳞癌患者保留卵巢组与未保留卵巢组的五年生存率分别为66.7%、67.3%,比较两组生存率,差异无显著性(P0.05)。5.根据Kaplan-Meier法计算宫颈非鳞癌组5年总生存率为66.1%,鳞癌组为85.4%。经Log-rank法检验,宫颈非鳞癌组总生存时间较鳞癌组短,两组差异有统计学意义(P=0.003)。结论:1.非鳞癌患者绝经前同绝经后比较,同时两组发病的组织病理学类型比较有显著性差异。提示宫颈非鳞癌的某些病理类型可能与年龄及激素水平有关。2.宫颈细胞学筛查宫颈腺体异常的阳性率相比宫颈鳞癌要低。非鳞癌的临床特点决定了其存在一定的漏诊及误诊率,它的早期诊断问题应该引起重视。对于TCT、HPV阴性但存在临床症状的患者,需及时行妇科检查,如检查发现宫颈管增粗,或宫颈质地较硬,此时应同时行宫颈管诊刮或宫颈管组织活检,必要时可行诊断性锥切。3.对于早期无中危因素或高危因素的宫颈非鳞癌患者,保留卵巢并没有增加死亡率。所以目前我们认为年轻的早期宫颈非鳞癌患者,保留卵巢是相对安全的,可以提高患者的生活质量,同时减少去势带来的长期副作用。4.宫颈非鳞癌的预后较宫颈鳞癌差,FIGO分期、局部大病灶、淋巴结转移及宫颈深间质浸润是影响预后的因素。
[Abstract]:Objective: cervical cancer is one of the most common malignant tumors of gynecologists. With the popularization of cervical screening in China, the incidence of cervical squamous cell carcinoma is increased in the precancerous stage, and the incidence of squamous cell carcinoma is reduced. However, the early clinical manifestations of cervical non squamous cell carcinoma are relatively indistinct, most of them are in the cervical canal and cervical adenocarcinoma. In cytological screening, the proportion of false negative is higher, and it is not easy to be diagnosed in the precancerous lesion stage. The incidence of false negative diagnosis is easy to occur. Clinical features, diagnosis, ovarian metastasis and treatment and prognosis. Methods: the clinical and pathological data of 35 cases of cervical non squamous cell carcinoma and 228 cases of cervical squamous cell carcinoma in the army general hospital from 2010-01 to 2016-05 months were retrospectively analyzed. Results: 1. non squamous carcinoma patients accounted for the cervical malignancy at the same time. The 13.3%.35 cases of non squamous carcinoma of the cervix were 25--76 years old, the average age was (50.7 + 13.3) years, 18 cases (51.4%) before menopause, 17 cases of postmenopausal patients (48.6%).35 cases of cervical non squamous carcinoma, 12 cases of cervical adenocarcinoma (34.3%), 9 cases of mucinous adenocarcinoma (25.7%), 6 cases of adenosscale carcinoma (17.1%), adenosarcoma carcinomas, adenosarcoma. Cases (2.9%). There were significant differences in histopathological types between premenopausal and postmenopausal non squamous cell carcinomas (P0.05) 20 cases of abnormal vaginal bleeding (57.1%), 2 cases of vaginal water or mucous like drainage (5.7%), 10 vaginal discharge with vaginal bleeding (28.6%), 3 cases (8.6%) with asymptomatic physical examination, and cervical part of the cervix. There were 21 cases of polyp like or cauliflower like tumors, 6 cases of ulcerative type, 8 cases with smooth surface, 34.3% in the non squamous cell carcinoma group and 18.9% in the cervical squamous cell carcinoma group, and 18.9% in the cervical squamous cell carcinoma group, and 22.9% in the non squamous carcinoma group. The patients in the cervical squamous cell carcinoma group accounted for 9.3%, the two groups were significantly different.I, the pelvic lymph node metastasis rate of the non squamous cell carcinoma patients in the II stage was 22.2%, and the pelvic lymph node metastasis of the other squamous cell carcinoma was 17.1%. The two groups had no significant difference (P0.05).3. non squamous carcinoma cervical cytology test: 20 cases underwent cervical cytological examination before treatment, of which cells were detected in the cervical cytology before treatment. 12 cases (60%) and 8 normal.15 cases were detected by HPV, of which 7 cases (47%) were positive for HPV high risk subtype infection, of which 5 cases were HPV16 or (and) 18 type.4. non squamous cell carcinoma patients, and 7 cases were retained ovaries, and 18 cases were operated on bilateral ovaries in the same period (IB stage, II phase). Non squamous carcinoma patients retained ovarian and unreserved eggs. The five year survival rate of the nesting group was 66.7% and 67.3% respectively. There was no significant difference in the survival rate of the two groups (P0.05). The total 5 year survival rate of the cervical non squamous cell carcinoma group was 66.1% according to the Kaplan-Meier method. The squamous cell carcinoma group was examined by Log-rank, the total survival time of the cervical non squamous cell carcinoma group was shorter than that of the squamous carcinoma group, and the two groups were statistically significant (P=0.003). 1. patients with non squamous cell carcinoma were compared with postmenopause before menopause, and there were significant differences in histopathological types between the two groups. It was suggested that some pathological types of non squamous carcinoma of the cervix may be related to age and hormone levels. The positive rate of.2. cervical cytology screening cervical gland abnormalities is lower than that of cervical squamous cell carcinoma. It is determined that there is a certain rate of missed diagnosis and misdiagnosis, and its early diagnosis should be paid attention to. For patients with TCT, HPV negative but with clinical symptoms, a gynecologic examination should be carried out in time, such as checking the thickening of the cervix tube, or the hard cervix of the cervix, at the same time, the cervical spinal cord or cervical tube biopsy should be performed at the same time, and the diagnostic cone should be practicable when necessary. The retention of the ovaries does not increase the mortality rate for patients with early non medium risk factors or high risk factors of cervical non squamous cell carcinoma. Therefore, we think that in the young patients with early cervical non squamous cell carcinoma, it is relatively safe to retain the ovary, which can improve the quality of life of the patients and reduce the long-term side effects of the castration,.4. cervical non squamous carcinoma. Prognosis is worse than cervical squamous cell carcinoma, FIGO stage, local large lesion, lymph node metastasis and deep cervical stromal invasion are prognostic factors.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
本文编号：2166037
[Abstract]:Objective: cervical cancer is one of the most common malignant tumors of gynecologists. With the popularization of cervical screening in China, the incidence of cervical squamous cell carcinoma is increased in the precancerous stage, and the incidence of squamous cell carcinoma is reduced. However, the early clinical manifestations of cervical non squamous cell carcinoma are relatively indistinct, most of them are in the cervical canal and cervical adenocarcinoma. In cytological screening, the proportion of false negative is higher, and it is not easy to be diagnosed in the precancerous lesion stage. The incidence of false negative diagnosis is easy to occur. Clinical features, diagnosis, ovarian metastasis and treatment and prognosis. Methods: the clinical and pathological data of 35 cases of cervical non squamous cell carcinoma and 228 cases of cervical squamous cell carcinoma in the army general hospital from 2010-01 to 2016-05 months were retrospectively analyzed. Results: 1. non squamous carcinoma patients accounted for the cervical malignancy at the same time. The 13.3%.35 cases of non squamous carcinoma of the cervix were 25--76 years old, the average age was (50.7 + 13.3) years, 18 cases (51.4%) before menopause, 17 cases of postmenopausal patients (48.6%).35 cases of cervical non squamous carcinoma, 12 cases of cervical adenocarcinoma (34.3%), 9 cases of mucinous adenocarcinoma (25.7%), 6 cases of adenosscale carcinoma (17.1%), adenosarcoma carcinomas, adenosarcoma. Cases (2.9%). There were significant differences in histopathological types between premenopausal and postmenopausal non squamous cell carcinomas (P0.05) 20 cases of abnormal vaginal bleeding (57.1%), 2 cases of vaginal water or mucous like drainage (5.7%), 10 vaginal discharge with vaginal bleeding (28.6%), 3 cases (8.6%) with asymptomatic physical examination, and cervical part of the cervix. There were 21 cases of polyp like or cauliflower like tumors, 6 cases of ulcerative type, 8 cases with smooth surface, 34.3% in the non squamous cell carcinoma group and 18.9% in the cervical squamous cell carcinoma group, and 18.9% in the cervical squamous cell carcinoma group, and 22.9% in the non squamous carcinoma group. The patients in the cervical squamous cell carcinoma group accounted for 9.3%, the two groups were significantly different.I, the pelvic lymph node metastasis rate of the non squamous cell carcinoma patients in the II stage was 22.2%, and the pelvic lymph node metastasis of the other squamous cell carcinoma was 17.1%. The two groups had no significant difference (P0.05).3. non squamous carcinoma cervical cytology test: 20 cases underwent cervical cytological examination before treatment, of which cells were detected in the cervical cytology before treatment. 12 cases (60%) and 8 normal.15 cases were detected by HPV, of which 7 cases (47%) were positive for HPV high risk subtype infection, of which 5 cases were HPV16 or (and) 18 type.4. non squamous cell carcinoma patients, and 7 cases were retained ovaries, and 18 cases were operated on bilateral ovaries in the same period (IB stage, II phase). Non squamous carcinoma patients retained ovarian and unreserved eggs. The five year survival rate of the nesting group was 66.7% and 67.3% respectively. There was no significant difference in the survival rate of the two groups (P0.05). The total 5 year survival rate of the cervical non squamous cell carcinoma group was 66.1% according to the Kaplan-Meier method. The squamous cell carcinoma group was examined by Log-rank, the total survival time of the cervical non squamous cell carcinoma group was shorter than that of the squamous carcinoma group, and the two groups were statistically significant (P=0.003). 1. patients with non squamous cell carcinoma were compared with postmenopause before menopause, and there were significant differences in histopathological types between the two groups. It was suggested that some pathological types of non squamous carcinoma of the cervix may be related to age and hormone levels. The positive rate of.2. cervical cytology screening cervical gland abnormalities is lower than that of cervical squamous cell carcinoma. It is determined that there is a certain rate of missed diagnosis and misdiagnosis, and its early diagnosis should be paid attention to. For patients with TCT, HPV negative but with clinical symptoms, a gynecologic examination should be carried out in time, such as checking the thickening of the cervix tube, or the hard cervix of the cervix, at the same time, the cervical spinal cord or cervical tube biopsy should be performed at the same time, and the diagnostic cone should be practicable when necessary. The retention of the ovaries does not increase the mortality rate for patients with early non medium risk factors or high risk factors of cervical non squamous cell carcinoma. Therefore, we think that in the young patients with early cervical non squamous cell carcinoma, it is relatively safe to retain the ovary, which can improve the quality of life of the patients and reduce the long-term side effects of the castration,.4. cervical non squamous carcinoma. Prognosis is worse than cervical squamous cell carcinoma, FIGO stage, local large lesion, lymph node metastasis and deep cervical stromal invasion are prognostic factors.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
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