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目的探讨宫颈微偏腺癌(MDA)的临床特征、诊断、治疗及预后。方法对我院1985年1月至2008年1月收治的21例MDA患者的临床和病理资料进行回顾性分析。结果本组病例占同期宫颈腺癌治疗患者的4.0%。临床主要特征为水样或黏液样白带(61.9%)和不规则阴道出血(42.9%)。治疗前仅5例(23.8%)初次宫颈活检诊断出MDA。14例患者经过2~5次宫颈活检或锥切才最终确诊,确诊时间1~25个月(中位时间2个月)。临床分期:ⅠB期4例;ⅡA期2例,ⅡB期5例;ⅢB期8例;外院治疗后无法分期者2例。11例ⅡB期以上者行根治性放化疗,全部肿瘤未控于7~26个月死亡;8例ⅡB期以下者行广泛性子宫切除术,有5例术后辅助放化疗,术后随访12~97个月,无一例死于本病;2例外院全宫双附件切除术后患者,1例阴道残端复发后行放疗肿瘤未控死亡,1例经补充手术及术后放疗无瘤生存。结论MDA常规活检诊断率低。早期患者应尽量采用根治性手术,对晚期患者实施放化疗效果差。及时确诊是治疗的关键。
Objective To investigate the clinical features, diagnosis, treatment and prognosis of cervical micro-adenocarcinoma (MDA). Methods The clinical and pathological data of 21 patients with MDA admitted to our hospital from January 1985 to January 2008 were retrospectively analyzed. Results This group of patients accounted for 4.0% of patients with cervical adenocarcinoma over the same period. The main clinical features are watery or mucoid leucorrhea (61.9%) and irregular vaginal bleeding (42.9%). Only 5 patients (23.8%) had an initial cervical biopsy to diagnose MDA before treatment. 14 patients after 2 to 5 cervical biopsy or conization before the final diagnosis, diagnosis of 1 to 25 months (median 2 months). Clinical stage: Ⅰ B 4 cases; Ⅱ A 2 cases, Ⅱ B 5 cases; Ⅲ B 8 cases; outside the hospital can not be staged in 2 cases. Radical chemotherapy was performed in 11 cases of stage IIB and all the tumors were uncontrolled in 7 to 26 months. In 8 cases of stage IIB, extensive hysterectomy was performed and in 5 cases postoperative adjuvant chemotherapy and radiotherapy were followed up 12 ~ 97 months, none of the patients died of this disease; 2 patients were excluded from the hospital after double-attachment excision, one case of recurrent vaginal stump was treated with radiotherapy and tumor uncontrolled death, 1 case was treated with surgery and postoperative radiotherapy-free survival . Conclusion The diagnostic rate of routine biopsy of MDA is low. Early patients should try to use radical surgery, the implementation of radiotherapy and chemotherapy in patients with poor performance. Timely diagnosis is the key to treatment.