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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 investigate the clinical and pathological features, treatment and prognosis of villoglandular adenocarcinoma (VGA). Methods The clinical features, pathology, treatment and follow-up of 7 patients with Peking University Third Hospital and 2 Beijing Women and Children Hospital from November 2009 to November 2015 were retrospectively analyzed. Age 33 to 58 years, median 43 years. The main symptoms were vaginal discharge (4 cases) or vaginal irregular bleeding (3 cases). The International Union of Obstetrics and Gynecology (FIGO) staging Ⅰ A2 period in 1 case, ⅠB1 in 5 cases, Ⅱ A2 in 1 case, Ⅱ B in 2 cases. One case of stage ⅠA2 patients after conical resection; 5 cases of stage ⅠB1 patients without reproductive requirements, laparoscopic radical hysterectomy + double attachment removal + pelvic lymph node dissection ± para-aortic lymph node dissection, of which 3 cases after surgery Adjuvant radiotherapy and chemotherapy; 1 case of stage Ⅱ A2 cervical cancer radical operation; 2 cases of Ⅱ B period in 1 case of neoadjuvant concurrent chemoradiotherapy after bilateral ureteral stenting + laparoscopic subtotal uterine double-attachment resection, and the other 1 case of laparoscopic Double attachment resection + pelvic and abdominal aortic lymph node dissection, postoperative radiotherapy and chemotherapy. Results In 7 cases of lymph node dissection, 1 case of stage Ⅱ B pelvic lymph node infiltration. In 8 cases of ovariectomy in 1 case of stage Ⅱ B no ovarian surface abnormalities in postoperative pathology, bilateral ovarian differentiated adenocarcinoma. All cases were followed up for 3 to 75 months with a median of 27 months without recurrence and death. Conclusions Compared with the common pathological types of cervical cancer, the incidence of VGA is relatively young. The growth of tumors is exogenous and the rate of lymph node and ovarian metastasis is low. The prognosis is good. However, due to the relatively small number of cases and a retrospective analysis, it is difficult to draw convincing conclusions.