放疗后近期子宫切除治疗局部晚期宫颈癌  

Full Dose Radiotherapy Followed by Hysterectomy in the Treatment of Local Advanced Cervical Cancer

作　　者：王伊洵[1] 曹品江[1] 曾庆东[1] 

机构地区：[1]辽宁省肿瘤医院,沈阳110042

出　　处：《浙江肿瘤》1999年第1期15-17,共3页

摘　　要：［目的］探讨局部晚期宫颈癌能否通过全量或近全量放疗后补充子宫切除术，提高局部控制率。［方法］２４例宫颈癌，平均年龄４０岁，病理证实腺癌７例，鳞癌１７例；按ＦＩＧＯ分期Ⅱｂ１７例，Ⅲｂ７例；宫颈呈桶型或大块型，直径均大于４ｃｍ；术前行常规综合放疗，放射剂量（Ａ点）大于７０００ｃＧｙ１９例，大于６０００ｃＧｙ３例，大于５０００ｃＧｙ２例；放疗结束后１～６周内行筋膜外子宫切除术４例，次广泛切除１８例，广泛切除加盆腔淋巴结清扫术２例。［结果］治疗完成至今５个月至４０个月，平均１６个月，期间６例未控或复发，近期治疗失败率为２５％（６／２４）。放疗后仍有可查到盆腔和（或）腹主动脉旁淋巴结转移者，治疗成功率为２０％（１／５）；放疗后局部持续性肿瘤者，治疗成功率为７５％（８／１２）；放疗后局部无持续肿瘤者（包括宫颈间质中见变性癌细胞团者）治疗成功率为８３．３％（１０／１２）；而既无淋巴结转移，又无宫颈持续肿瘤者治疗成功率为９０．９７％（１０／１１）。有术后并发症者２例，经保守治疗治愈。［结论］对于局部大块型、放疗后反应不良、某些高危病理类型及局部解剖条件不良的宫颈癌，放疗后近期补充子宫切除术可作为一种治疗方法，能提高治愈率?Purpose] To determine whether radiotherapy and adjuvent hysterectomy can improve local control rate of local advanced cervical cancer. [Method] Twenty - four patients with histologically confirmed cervical cancer were treated by a combination of full dose radiotherapy followed by hysterectomy. Patients' average age was 40 years old. Histological type included squamous cell carcinoma (17 cases), adenocarcinoma (7 cases). Patients staged according to FIGO system, there were 17 cases in Ⅱb and 7 cases in Ⅲb. Cervical appearance was either barrel - shaped or bulky mass, with diameter dose > 4cm. Radiation > 7000cGy in 19 cases, > 6000cGy in 3 cases, > 5000cGy in 2 cases. [Result] Average follow -up time was 16 months (10 - 40 months). Within this period, there were 6 cases with persistent disease or early recurrent, short term failure occurred in 25% (6/24). Complete remission rate for patients with pelvic or para - aortic lymph node metastasis after radiation was 20% (1/5), that for those with or without local persistent tumor was 75 % (8/12) and 83. 2% (10/12) respectively, for those with neither lymph node metastasis nor persistent tumor was 90.7% (10/11). [Conclusion] For the patients with bulky tumor, resistent to radiation, high - risk pathological type and poor vagina anatomy, radiotherapy followed by adjuvent hysterectomy can improve local control rate, but the dose of radiation should be conservative, and the interval from radiation to operation should not be too long. Hysterectomy dose not benefit the patient with lymph node metastasis after radiation.

关 键 词：宫颈肿瘤 放射疗法 子宫切除术 治疗 

分 类 号：R737.330.5[医药卫生—肿瘤]