【摘要】：目的:宮頸癌是婦科醫(yī)生最常遇見的惡性腫瘤之一。隨著宮頸篩查在國內(nèi)的普及,宮頸鱗癌在癌前病變階段被檢查出的幾率增高,鱗癌的發(fā)病率有所降低,但宮頸非鱗癌早期的臨床表現(xiàn)相對(duì)不典型,多在宮頸管內(nèi)生長(zhǎng),同時(shí)宮頸腺癌進(jìn)行細(xì)胞學(xué)篩查時(shí),出現(xiàn)假陰性的比例較高,在癌前病變階段不易被診斷,容易出現(xiàn)漏診。導(dǎo)致發(fā)病率相對(duì)有所上升,尤其在年輕女性中。本研究通過對(duì)宮頸非鱗狀細(xì)胞惡性腫瘤的臨床病例進(jìn)行分析,討論宮頸非鱗狀細(xì)胞惡性腫瘤(以下簡(jiǎn)稱非鱗癌)的臨床特征、診斷、卵巢轉(zhuǎn)移情況及治療和預(yù)后。為臨床治療提供指導(dǎo)。方法:對(duì)陸軍總醫(yī)院2010-01到2016-05月收治的35例宮頸非鱗癌患者與同期228例宮頸鱗癌患者的臨床及病理資料進(jìn)行回顧性分析。結(jié)果:1.非鱗癌患者占同期宮頸惡性腫瘤的13.3%。35例宮頸非鱗癌患者年齡25--76歲,平均年齡(50.7±13.3)歲。絕經(jīng)前患者18例(51.4%),絕經(jīng)后患者17例(48.6%)。35例宮頸非鱗癌中宮頸腺癌12例(34.3%),黏液腺癌9例(25.7%),腺鱗癌6例(17.1%),神經(jīng)內(nèi)分泌癌6例(17.1%),肉瘤樣癌1例(2.9%),腺肉瘤1例(2.9%)。絕經(jīng)前與絕經(jīng)后非鱗癌發(fā)病的組織病理類型對(duì)比存在顯著性差異(P0.05)。2.非鱗癌患者的臨床表現(xiàn)陰道異常出血20例(57.1%),陰道水樣或黏液樣排液2例(5.7%),陰道排液伴有陰道出血10例(28.6%),無癥狀體檢發(fā)現(xiàn)者3例(8.6%)。子宮頸局部表現(xiàn):宮頸表面有外生型腫瘤、呈息肉狀或菜花狀21例,潰瘍型6例,表面光滑者8例。宮頸非鱗癌組以陰道排液為主要癥狀就診的比例為34.3%,而宮頸鱗癌組以該臨床表現(xiàn)就診的患者只有18.9%;非鱗癌組宮頸光滑無肉眼可見病灶占22.9%,而宮頸鱗癌組該表現(xiàn)的患者占9.3%,兩組比較差異顯著。I、II期非鱗癌患者盆腔淋巴結(jié)轉(zhuǎn)移率為22.2%,同期別鱗癌出現(xiàn)盆腔淋巴結(jié)轉(zhuǎn)移的為17.1%,兩組比較差異無顯著性(P0.05)。3.非鱗癌組宮頸細(xì)胞學(xué)檢測(cè):20例治療前行宮頸細(xì)胞學(xué)檢測(cè),其中細(xì)胞學(xué)異常12例(60%),正常8例。15例患者行HPV檢測(cè),其中陽性者7例(47%),均為HPV高危亞型感染,其中5例為HPV16或(和)18型感染。4.非鱗癌患者中有7例保留卵巢,同期(IB期、II期)行手術(shù)治療切除雙側(cè)卵巢的患者18例。非鱗癌患者保留卵巢組與未保留卵巢組的五年生存率分別為66.7%、67.3%,比較兩組生存率,差異無顯著性(P0.05)。5.根據(jù)Kaplan-Meier法計(jì)算宮頸非鱗癌組5年總生存率為66.1%,鱗癌組為85.4%。經(jīng)Log-rank法檢驗(yàn),宮頸非鱗癌組總生存時(shí)間較鱗癌組短,兩組差異有統(tǒng)計(jì)學(xué)意義(P=0.003)。結(jié)論:1.非鱗癌患者絕經(jīng)前同絕經(jīng)后比較,同時(shí)兩組發(fā)病的組織病理學(xué)類型比較有顯著性差異。提示宮頸非鱗癌的某些病理類型可能與年齡及激素水平有關(guān)。2.宮頸細(xì)胞學(xué)篩查宮頸腺體異常的陽性率相比宮頸鱗癌要低。非鱗癌的臨床特點(diǎn)決定了其存在一定的漏診及誤診率,它的早期診斷問題應(yīng)該引起重視。對(duì)于TCT、HPV陰性但存在臨床癥狀的患者,需及時(shí)行婦科檢查,如檢查發(fā)現(xiàn)宮頸管增粗,或?qū)m頸質(zhì)地較硬,此時(shí)應(yīng)同時(shí)行宮頸管診刮或?qū)m頸管組織活檢,必要時(shí)可行診斷性錐切。3.對(duì)于早期無中危因素或高危因素的宮頸非鱗癌患者,保留卵巢并沒有增加死亡率。所以目前我們認(rèn)為年輕的早期宮頸非鱗癌患者,保留卵巢是相對(duì)安全的,可以提高患者的生活質(zhì)量,同時(shí)減少去勢(shì)帶來的長(zhǎng)期副作用。4.宮頸非鱗癌的預(yù)后較宮頸鱗癌差,FIGO分期、局部大病灶、淋巴結(jié)轉(zhuǎn)移及宮頸深間質(zhì)浸潤是影響預(yù)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 魏特曼;王樹鶴;;宮頸非鱗狀細(xì)胞惡性腫瘤35例臨床病例分析[J];中國婦產(chǎn)科臨床雜志;2017年01期

2 萬挺;劉繼紅;;宮頸腺癌的治療進(jìn)展[J];實(shí)用婦產(chǎn)科雜志;2016年08期

3 周暉;林仲秋;;美國國立綜合癌癥網(wǎng)絡(luò)“2016宮頸癌臨床實(shí)踐指南”解讀[J];中國實(shí)用婦科與產(chǎn)科雜志;2016年03期

4 何勉;郭朋;馮凱勛;夏夢(mèng);劉軍秀;;宮頸腺癌125例預(yù)后分析[J];中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版);2012年04期

5 周新華;宋磊;郭一帆;付曉宇;;宮頸腺癌86例臨床分析[J];中國婦產(chǎn)科臨床雜志;2010年05期

6 梁志清;;子宮頸癌腹腔鏡下廣泛子宮切除和盆腔淋巴結(jié)清掃術(shù)的優(yōu)勢(shì)[J];腹腔鏡外科雜志;2008年02期

7 李華,章文華,張蓉,吳令英,李曉光,白萍;子宮頸腺癌159例預(yù)后影響因素分析[J];中華婦產(chǎn)科雜志;2005年04期

8 廖秦平;宮頸癌病因?qū)W研究新進(jìn)展[J];中國婦產(chǎn)科臨床;2003年04期

，

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