本文選題：早期宮頸癌 + 改良根治術(shù)�。� 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：目的：探討早期宮頸癌(IA1-IB1期)患者宮旁轉(zhuǎn)移的低危因素,總結(jié)符合低危因素的患者行改良根治性子宮切除術(shù)的可行性。方法：回顧性分析2008～2011年間復(fù)旦大學(xué)附屬婦產(chǎn)科醫(yī)院收治的IA1-IB1期宮頸癌患者(共602例)行根治性子宮切除+盆腔淋巴結(jié)清掃術(shù)后,患者腫瘤大小、浸潤深度、脈管內(nèi)癌栓、切除范圍(陰道壁長度、宮旁組織寬度)、部分免疫組化指標(biāo)(CD31、D2-40、AE1/AE3)及預(yù)后生存情況,用統(tǒng)計(jì)學(xué)方法找到影響宮旁轉(zhuǎn)移及生存結(jié)局的低危因素。結(jié)果：602名行根治性子宮切除+盆腔淋巴結(jié)清掃術(shù)的患者手術(shù)病理特點(diǎn)：中位年齡45歲,FIG0分期：IA1期36(6.0%),IA2期14例(2.3%),IBl期552例(91.7%),腫瘤直徑≤2cm者354例(58.8%),浸潤深度1/2肌層者371例(61.6%),脈管內(nèi)未見癌栓(無脈管累及)者411例(68.3%),兩側(cè)宮旁組織切除寬度中位數(shù)3cm(兩側(cè)均大于等于3cm占42.9%),陰道壁切除長度中位數(shù)2.7cm,宮旁組織轉(zhuǎn)移者23例(3.8%),盆腔淋巴結(jié)轉(zhuǎn)移者69例(11.5%)。對(duì)以上數(shù)據(jù)進(jìn)行Binary Logstic回歸分析,結(jié)果顯示病灶直徑≤2cm、肌層浸潤1/2、脈管內(nèi)未見癌栓與宮頸癌宮旁轉(zhuǎn)移間有顯著意義(P0.05),為保護(hù)性因素(低危因素),同時(shí)符合3項(xiàng)低危因素的263例患者,宮旁轉(zhuǎn)移率降為0.007%。602例患者隨訪12-60個(gè)月,27例死于宮頸癌。Cox生存模型分析,結(jié)果顯示病灶直徑≤2cm、肌層浸潤1/2、脈管內(nèi)未見癌栓對(duì)宮旁轉(zhuǎn)移及生存結(jié)局的影響有顯著意義(P0.05),為保護(hù)性因素(低危因素),宮旁組織切除寬度是否3cm對(duì)生存結(jié)局無顯著影響(P0.05)。結(jié)論：腫瘤直徑≤2cm,肌層浸潤1/2,脈管內(nèi)無癌栓是早期宮頸癌(IAI-IBI期)宮旁轉(zhuǎn)移的低危因素,且宮旁組織切除寬度是否3cm對(duì)生存結(jié)局無顯著影響,符合以上三項(xiàng)低危因素的患者有行改良根治性子宮切除術(shù)+盆腔淋巴結(jié)清掃術(shù)的可行性。
[Abstract]:Objective: to investigate the low risk factors of pariuterine metastasis in patients with early cervical cancer (stage I I I) and to summarize the feasibility of modified radical hysterectomy in patients with low risk factors. Methods: from 2008 to 2011, 602 patients (602 cases) with IA1-IB1 cervical cancer treated in Department of Obstetrics and Gynecology, Fudan University, underwent radical hysterectomy, pelvic lymph node dissection, tumor size, depth of invasion, intravascular cancer thrombus. The range of resection (length of vagina wall, width of para-uterine tissue, partial immunohistochemical index CD31D2-40AE1 / AE3) and survival status of prognosis were analyzed. The low risk factors influencing para-uterine metastasis and survival outcome were found by statistical method. Results the pathological features of 552 patients with radical hysterectomy and pelvic lymph node dissection were as follows: the median age was 45 years old and the median age was 45 years old. There were 14 patients with stage I 36 ~ 6.0D and 14 patients with stage I I ~ (2). 552 patients with stage I ~ (2) were treated with IBL. The diameter of tumor 鈮，

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