基础医学与临床 ›› 2013, Vol. 33 ›› Issue (3): 264-269.

• 宫颈腺癌和少见宫颈癌专题 • 上一篇    下一篇

宫颈透明细胞癌28例临床分析

蒋湘1,金滢1,1,李艳1,黄惠芳1,吴鸣1,沈铿2,潘凌亚3   

  1. 1. 北京协和医院妇产科
    2. 北京协和医院妇产科 北京
    3. 中国医学科学院 北京协和医学院 北京协和医院
  • 收稿日期:2012-12-25 修回日期:2013-01-14 出版日期:2013-03-05 发布日期:2013-03-05
  • 通讯作者: 潘凌亚 E-mail:lingyapan@hotmail.com

Clear cell carcinoma of the cervix: a report of twenty-eight cases

  • Received:2012-12-25 Revised:2013-01-14 Online:2013-03-05 Published:2013-03-05
  • Contact: Ling-ya PAN E-mail:lingyapan@hotmail.com

摘要: 目的:探讨宫颈透明细胞癌的临床病理特点及预后影响因素。方法:回顾性分析1986年8月至2012年6月我院收治的原发性宫颈透明细胞癌患者28例,分析患者年龄分布、临床病理特点、预后及其影响因素。结果:患者平均年龄38.1岁(12~74岁),其中35.7%(10例)年龄小于30岁,35.7%(10例)尚未生育。均否认宫内乙烯雌酚暴露史。患者主要表现为不规则阴道出血、接触性阴道出血及阴道排液。55% CA125升高。Ⅰ期患者占53.8%,Ⅱ期32.1%,Ⅲ期7.1%,Ⅳ期3.8%。4例患者宫颈外观正常;5例为桶状宫颈;17(60.6%)例宫颈肿物为外生型。19例手术治疗患者术后病理7例有宫颈深肌层浸润,1例脉管累及,1例盆腔淋巴结阳性,5例累及子宫体,1例累及阴道。28例患者平均随访33.3月(2~128月),1例未控,2例复发,1例死亡,5年无瘤生存率74.6%。其中,Ⅰ至Ⅱa2期5年无瘤生存80.8%。3例行保留生育功能治疗,随访8、16、54月后未复发。结论:宫颈透明细胞癌的发病年龄较轻,内生型肿瘤多见,诊断时多数患者处于临床早期;早期患者具有较好的5年生存率,保留生育功能的手术治疗具有可行性。

Abstract: Objective To explore the clinical characteristics and prognostic factors of clear cell carcinoma of the cervix(CCCC). Methods Retrospective review was conducted on twenty-eight cases of CCCC and the features of age distribution , histopathology, prognosis and related factors were observed. Results The mean age was 38.1 years (12~74 years ), ten cases (35.7%) with age less than thirty years. Ten cases (35.7%) had not given birth. No diethylstilbestrol exposure was confirmed. Patients mostly presented abnormal bleeding and vaginal discharge. Elevated ca125 was detected in 55% of patients. The stage distribution was 53.8% stageⅠ,32.1% stageⅡ,7.1% stageⅢ,and 3.8% stageⅣ. Four cases had normal cervix, two presenting endocervical neoplasm and two showing pelvic lumps. Five cases had barrel cervix. Seventeen patients had exophytic neoplasm. Surgical treatments were performed in nineteen cases among whom seven had deep cervical infiltration , one having vascular invasion, one with positive lymph node and none with parametrial invasion. After a follow-up of 33.3 months one was uncontrolled, two relapsed and one died. Patients stagingⅠorⅡ had superior five year free survival compared to the whole patients(80.8%vs74.6%). Three cases had fertility-preserving operations and none suffered recurrence after eight to fifty-four months 'follow-up. Conclusion CCCC tend to affect young patients and often presented endocervical neoplasm. The early stage CCCC patients which account for the most of the cases had favorable prognosis. Fertility-sparing treatment is applicable in selected cases.