13例年轻局部晚期宫颈鳞状细胞癌手术方式探讨(1)
[摘要] 目的 探讨年轻局部晚期宫颈癌患者手术分期同时保留生殖内分泌功能的治疗方式。 方法 选取2016年5月～2018年3月首都医科大学附属北京妇产医院收治的<40岁的局部晚期宫颈癌患者13例，放射治疗前均进行腹腔镜手术分期及卵巢冻存，回顾病例资料，评估CT/MRI判断淋巴结转移准确性及生殖内分泌功能保留的可行性。 结果 局部晚期宫颈癌患者应用CT/MRI评估淋巴转移灵敏度为66.7%，特异度为70.0%。13例患者进行卵巢冻存，2例患者治疗后行卵巢移植术，激素水平稳定，更年期症状完全缓解。 结论 CT/MRI评估淋巴结转移情况灵敏度及特异性欠佳，局部晚期宫颈癌行腹腔镜盆腔、腹主动脉旁淋巴结切除术是评估淋巴结转移情况的重要手段，卵巢冻存可成为解决年轻宫颈癌患者保存和恢复生殖内分泌功能的新选择。
[关键词] 年轻局部晚期宫颈癌;手术分期;卵巢冻存
[中图分类号] R713.6 [文献标识码] A [文章编号] 1673-7210(2020)02(c)-0099-04
[Abstract] Objective To explore the surgical stage of young patients with locally advanced cervical cancer while preserving reproductive endocrine function. Methods From May 2016 to March 2018， 13 cases of locally advanced cervical cancer patients < 40 years old admitted to Beijing Obstetrics and Gynecology Hospital， Capital Medical University were selected. Laparoscopic surgical staging and ovarian cryopreservation were performed before radiotherapy. Case data were reviewed to evaluate the accuracy of CT/MRI in judging lymph node metastasis and the feasibility of preserving reproductive endocrine function. Results The sensitivity of lymph metastasis in patients with locally advanced cervical cancer was 66.7% by CT/MRI and Specificity was 70.0%. Thirteen patients underwent ovarian cryopreservation， and two underwent ovarian transplantation after treatment， with stable hormone levels and complete remission of menopausal symptoms. Conclusion CT/MRI is not sensitive and specific enough to evaluate lymph node metastasis. Laparoscopic pelvic and para-aortic lymph node resection for locally advanced cervical cancer is an important means to evaluate lymph node metastasis. Ovarian cryopreservation can be a new option to save and restore reproductive endocrine function in young cervical cancer patients.
[Key words] Young locally advanced cervical cancer; Surgical staging; Ovarian cryopreservation
宮颈癌是女性最常见的生殖系统恶性肿瘤之一，约78%的宫颈癌发生于发展中国家，其中我国约占世界新发病例的1/3[1]。在20～39岁年轻女性中，其发病率为9.9/100 000每年，死亡率为2.5/100 000每年，占所有致死恶性肿瘤的14.3%[2-3]。由于缺乏相关的知识及筛查的不足，很多女性发现患病的时候已经属于局部晚期。
国际妇产科联盟(International Federation of Gynecology and Obstetrics，FIGO)定义广义的局部晚期宫颈癌指ⅠB2～ⅣA期的宫颈癌，狭义的局部晚期宫颈癌指肿瘤直径>4 cm的早期宫颈癌，即ⅠB2、ⅡA2期宫颈癌。ⅠB1期宫颈癌5年生存率为80%～95%，ⅡA1期为79.7%，而ⅠB2和ⅡA2仅为50%～60%[4]，它们明显的预后差别可能与淋巴结转移相关[5]。淋巴转移是宫颈癌的一种重要的转移方式，2019年FIGO已把淋巴结转移情况列入新的宫颈癌分期[6]，目前影像学检查并不能完全反映出宫颈癌淋巴结转移的情况。
宫颈癌的发病年龄趋向于年轻化，局部晚期患者的治疗主要为放射治疗，低剂量的放射线就会使卵巢永久衰竭，有效保留生殖内分泌功能非常重要，最常用的卵巢移位成功率有限，同时存在一些并发症，因此我们希望患者接受放射治疗前先行腹腔镜手术评估淋巴结情况，并行卵巢冻存，为保留生殖内分泌功能提供一个新的选择。, 百拇医药(康海利 赵群 吴玉梅)
[关键词] 年轻局部晚期宫颈癌;手术分期;卵巢冻存
[中图分类号] R713.6 [文献标识码] A [文章编号] 1673-7210(2020)02(c)-0099-04
[Abstract] Objective To explore the surgical stage of young patients with locally advanced cervical cancer while preserving reproductive endocrine function. Methods From May 2016 to March 2018， 13 cases of locally advanced cervical cancer patients < 40 years old admitted to Beijing Obstetrics and Gynecology Hospital， Capital Medical University were selected. Laparoscopic surgical staging and ovarian cryopreservation were performed before radiotherapy. Case data were reviewed to evaluate the accuracy of CT/MRI in judging lymph node metastasis and the feasibility of preserving reproductive endocrine function. Results The sensitivity of lymph metastasis in patients with locally advanced cervical cancer was 66.7% by CT/MRI and Specificity was 70.0%. Thirteen patients underwent ovarian cryopreservation， and two underwent ovarian transplantation after treatment， with stable hormone levels and complete remission of menopausal symptoms. Conclusion CT/MRI is not sensitive and specific enough to evaluate lymph node metastasis. Laparoscopic pelvic and para-aortic lymph node resection for locally advanced cervical cancer is an important means to evaluate lymph node metastasis. Ovarian cryopreservation can be a new option to save and restore reproductive endocrine function in young cervical cancer patients.
[Key words] Young locally advanced cervical cancer; Surgical staging; Ovarian cryopreservation
宮颈癌是女性最常见的生殖系统恶性肿瘤之一，约78%的宫颈癌发生于发展中国家，其中我国约占世界新发病例的1/3[1]。在20～39岁年轻女性中，其发病率为9.9/100 000每年，死亡率为2.5/100 000每年，占所有致死恶性肿瘤的14.3%[2-3]。由于缺乏相关的知识及筛查的不足，很多女性发现患病的时候已经属于局部晚期。
国际妇产科联盟(International Federation of Gynecology and Obstetrics，FIGO)定义广义的局部晚期宫颈癌指ⅠB2～ⅣA期的宫颈癌，狭义的局部晚期宫颈癌指肿瘤直径>4 cm的早期宫颈癌，即ⅠB2、ⅡA2期宫颈癌。ⅠB1期宫颈癌5年生存率为80%～95%，ⅡA1期为79.7%，而ⅠB2和ⅡA2仅为50%～60%[4]，它们明显的预后差别可能与淋巴结转移相关[5]。淋巴转移是宫颈癌的一种重要的转移方式，2019年FIGO已把淋巴结转移情况列入新的宫颈癌分期[6]，目前影像学检查并不能完全反映出宫颈癌淋巴结转移的情况。
宫颈癌的发病年龄趋向于年轻化，局部晚期患者的治疗主要为放射治疗，低剂量的放射线就会使卵巢永久衰竭，有效保留生殖内分泌功能非常重要，最常用的卵巢移位成功率有限，同时存在一些并发症，因此我们希望患者接受放射治疗前先行腹腔镜手术评估淋巴结情况，并行卵巢冻存，为保留生殖内分泌功能提供一个新的选择。, 百拇医药(康海利 赵群 吴玉梅)
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