宫颈绒毛管状腺癌9例临床分析  

Clinical Study of 9 Cases of Villoglandular Adenocarcinoma of Uterine Cervix

作　　者：冯彩霞[1] 郭红燕[2] 孔东丽 贺豪杰[2] 张坤[2] 韩劲松[2] 熊光武[2] 闫霞[3] 孔为民[3] 

机构地区：[1]陕西省榆林市第一医院妇产科一病区,榆林719000 [2]北京大学第三医院妇产科,北京100083 [3]首都医科大学附属北京妇产医院肿瘤科,北京100026

出　　处：《中国微创外科杂志》2016年第9期807-811,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨宫颈绒毛管状腺癌（villoglandular adenocarcinoma,VGA）的临床及病理特征、处理方法及预后。方法回顾性分析2009年11月~2015年11月北京大学第三医院7例及北京妇产医院2例VGA患者的临床特征、病理结果、治疗方案以及随诊结局。年龄33~58岁,中位数43岁。主要症状为阴道排液（4例）或阴道不规则出血（3例）。国际妇产科联盟（FIGO）分期ⅠA2期1例,ⅠB1期5例,ⅡA2期1例,ⅡB期2例。1例ⅠA2期患者锥切后观察;5例ⅠB1期患者均无生育要求,行腹腔镜广泛性全子宫切除＋双附件切除＋盆腔淋巴结清扫±腹主动脉旁淋巴结清扫术,其中3例术后辅助放化疗;1例ⅡA2期行宫颈癌根治术;2例ⅡB期中1例新辅助同步放化疗后行双侧输尿管支架置入＋腹腔镜次广泛子宫双附件切除术,另1例行腹腔镜双附件切除＋盆腔及腹主动脉旁淋巴结清扫术,术后放化疗。结果 7例行淋巴结清扫者中ⅡB期1例盆腔淋巴结浸润。8例卵巢切除中1例ⅡB期术中卵巢表面未见异常,术后病理双侧卵巢中分化腺癌。随访3~75个月,中位数27个月,无术后复发及死亡。结论与常见病理类型的宫颈癌相比,VGA发病相对年轻,肿瘤多外生型生长,淋巴结及卵巢转移率低,预后良好。但由于病例数相对少,且为回顾性分析,难以得出十分有说服力的结论。Objective To explore the clinicopathologic features, management and prognosis of villoglandular adenocarcinoma （VGA） of uterine cervix. Methods From November 2009 to November 2015, a total of 9 cases of VGA were reviewed retrospectively. Their median age was 43 （33 -58） years old. The major symptoms were vaginal drainage （4 cases） and abnormal vaginal hemorrhage （3 cases）. And the International Federation of Gynecology and Obstetrics （FIGO） stages were 1 case of I A2, 5 cases of Ⅱ B1, 1 ease of Ⅱ A2, and 2 eases of Ⅱ B. One patient at stage I A2 was given observation after conization. Five patients at stage I B1 underwent laparoscopic radical hysterectomy and bilateral salpingo-oophorectomy （BSO） plus pelvic lymphadenectomy, with three patients of postoperative chemotherapy. One patient at stage ⅡA2 underwent radical hysterectomy plus pelvic lymphadeneetomy. One patient at stage Ⅱ B underwent radical hysterectomy with concurrent radiotherapy and chemotherapy, while another patient at stage ⅡB underwent radiotherapy and concurrent chemotherapy after BSO and pelvic lymphadeneetomy. Results Out of the 7 patients receiving lymphadenectomy, one stage ⅡB patient had positive pelvic lymph nodes. Out of the 8 patients receiving BSO, one stage Ⅱ B patient had moderately differentiated adenocarcinoma in ovarian. The median follow-up period was 27 months （range, 3 -75 months）. All the patients survived without recurrence. Conclusions VGA mainly affects younger women and the prognosis is generally fair with a lower rate of ovarian metastasis and lymphatic metastasis as compared to common forms of cervical cancer. Due to a limited sample size and retrospective clinical data study, muhi-center prospective studies are warranted for a better understanding of this disease.

关 键 词：宫颈肿瘤 宫颈绒毛管状腺癌 肿瘤转移 肿瘤复发 

分 类 号：R737.33[医药卫生—肿瘤]