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目的:通过大样本的病例回顾,明确宫颈微浸润腺癌需要彻底外科治疗的病变范围。方法:46例因患宫颈微浸润腺癌(浸润深度小于或等于5mm)行外科手术治疗的病人,来自中国人民解放军总医院妇产科,同一位病理专家确定组织学类型、肿瘤分级、浸润深度、肿瘤宽度、有无淋巴管间的浸润、肿瘤边缘状况、宫旁状况以及是否有结节状的转移。病变分级参照FIGO(2009)的标准。结果:46例患者按照现行的FIGO分期标准,34例ⅠA1期,12例ⅠA2期。治疗方式主要有宫颈锥切、单纯全子宫切除、全子宫切除加淋巴结清扫、广泛子宫切除加淋巴结清扫。31例广泛全子宫切除的患者没有发现宫旁浸润。34例行淋巴结清扫的病人没有发现淋巴结转移。平均随访80个月未见复发。结论:关于微浸润腺癌的处理仍旧有争议,相对于微浸润宫颈鳞状细胞癌而言,传统的治疗宫颈微浸润腺癌彻底外科治疗更多一些。通过本次研究,我们认为宫颈为浸润癌基质浸润深度小于3mm或者FIGOIA1期的患者,简单的全子宫切除足够,不需要淋巴结清扫、广泛的子宫切除和卵巢切除。
OBJECTIVE: To clarify the range of lesions that require complete surgical treatment of cervical micro-invasive adenocarcinoma through a large sample of patient reviews. METHODS: Forty-six patients undergoing surgical treatment due to cervical micro-invasive adenocarcinoma (infiltration depth less than or equal to 5 mm) were enrolled in the department of Obstetrics and Gynecology of Chinese PLA General Hospital. The same pathologist determined the histological type, tumor grade, depth of invasion , Tumor width, presence or absence of lymphatic invasion, tumor margins, paracancer status, and nodular metastases. Lesions grading reference FIGO (2009) standards. Results: 46 patients according to the current FIGO staging criteria, 34 cases of stage IA, 12 cases of stage IA. The main treatment of cervical conization, simple hysterectomy, hysterectomy plus lymph node dissection, extensive hysterectomy plus lymph node dissection. In 31 patients with extensive hysterectomy, no parametrial infiltration was found. No lymph node metastasis was found in 34 patients with lymph node dissection. The average follow-up of 80 months no recurrence. CONCLUSIONS: The management of micro-invasive adenocarcinomas remains controversial, as is the more radical treatment of conventional micro-invasive adenocarcinoma of the cervix relative to microinvasive cervical squamous cell carcinoma. Through this study, we conclude that simple cervical hysterectomy is adequate for patients with infiltrating cancerous stroma infiltrating less than 3 mm or FIGOIA1, without lymph node dissection, extensive hysterectomy, and ovariectomy.