| Objective Invasive cervical cancer is the most common gynecological malignancies. With the human papilloma virus (HPV) infection rates rise and changes in social life, the incidence of cervical cancer have the trend to increase and to be younger. So,Diagnosis and treatment of cervical cancer raised new questions.This study combine new progress of cervical cancer diagnosis and treatment, reference to the specific circumstances of my hospital to explore effective measures to reduce surgical complications and improve cure rate, from which we found that the gap between diagnosis and treatment at home and abroad.Methods Collected 634 gynecological hospitalization patients with cervical carcinoma in the Second Hospital of Jilin University.The time in January 2006-December 2008 as group B,the time in January 2003-December 2003 as group A. Collect those cases of age, marriage, childbearing and menstrual history, clinical symptoms and signs, laboratory examinations, tumor stage, treatment, postoperative pathology, complications, then analyze retrospectively.Results①The peak age of cervical cancer in this study is 44 to 46-year-old. This suggests the onset age has the smaller trend. And the incidence of cervical cancer has a correlation with Early sex life, pregnancy and beared to many times.②The patients have obvious symptoms accountd for 97%, mainly represent as contact bleeding (38%), irregular vaginal bleeding (39%) and vaginal discharge (50%). Cauliflower-like exogenous(49%), erosion or ulcer(39%), cervical canal hyperplasia(8%) are important signs of cervical cancer, and cervical smooth accounted for 4%.③All patients in this study, all have cervical biopsy,have cervical cytology examination accounted for 8%, have colposcopy accounted for only 4.64%.648 patients have transvaginal color Doppler examination (88.40%), detected abnormal 529 cases (81.645%). CT examination in 11 cases, all in the B group, accounted for 1.74%.④According to the International League of Obstetrics and Gynecology (FIGO2003) revised clinical staging criteria,733 patients in this study,442 cases of early stage cervical cancer (ⅡA stage and previous), accounting for 60%; 291 cases of late stage cervical cancer (ⅡB stage and beyond), accounting for 40%.672 cases of squamous cell carcinoma(91.7%); 31 cases of adenocarcinoma(4.2%), of which 12 cases of endometrial adenocarcinoma(38.7%); 22 cases of squamous adenocarcinoma (3%).Cell differentiation 142 cases in high level(20.5%); 473 cases in Moderate level(67.8%); 85 cases in low level(11.7%).The proportion of clinical stage in three groups is significant different, negative correlation.165 cases with lymph node metastasis(23.6%).⑤In group A 96 patients have surgical treatment,2 cases have sub-extensive abdominal hysterectomy (2.02%); 93 cases have extensive abdominal hysterectomy (93.94%); 1 case have cervical stump resection (1.01%); 3 cases have chemotherapy or Radiotherapy first,because of late stage or large focus of infection (3.03%). In group B 604 patients have surgical treatment.14 cases have Hysterectomy (2.21%).10 cases have sub-extensive abdominal hysterectomy (1.58%).569 cases have extensive abdominal hysterectomy(89.75%).3 cases have radical trachelectomy(0.63%).5 case have cervical stump resection (0.79%).30 cases have chemotherapy or Radiotherapy first,because of late stage or large focus of infection(4.73%). The rate of total attachment resection in 700 patients in surgery was 74%(517/700), group A was 77%(74/96), group B was 73%(438/604). In different age groups the three difference surgical method about attachment had statistical significance, means increased with age, the rate of attachment resection increased.The number of patients who had radiotherapy before surgery was 34, group A was 7, group B was 27.Been followed the number of patients who had radiotherapy after surgery was 82, group A was 5, group B was 77.The number of patients who had Chemotherapy was 110. Group A was 0 before surgery,8 after surgery.Group B was 31 before surgery,71 after surgery.⑥Group A had urinary retention was 6.3%,other complication was 15.9%. Group B had urinary retention was 5.2%,other complication was 6.9%.285 patients had been followed, Survival in 7 years was 71.4%,in 4 years was 85.1%,in 3 years was 86.7%,in 2 years was 93.8%.Conclusion①The onset age of cervical cancer had the smaller trend.The incidence of cervical cancer has a correlation with early sex life, pregnancy and beared to many times.②The patients had long case history and low rate of first diagnose,that mesned patients'awareness of disease and poor medical awareness were need to be improve.The mainly symptoms was contact bleeding, irregular vaginal bleeding and vaginal discharge.③Careful and accurate palpation and visual examination is an important anatomy examination, also a base of early diagnosis. Cervical cytology was a suitable examinations to screening,matching colposcop and tissue biopsy, cervical canal curettage or cervical conization pathology censorship when necessary. Cervical is the final diagnostic criteria of cervical cancer. Combination of hypersound CT and MR I, can improve the diagnostic accuracy.④Clinical stage and patient age determed the treatment method of cervical cancer. To improve the quality of life,surgical options have the trend to retained ovarian function, preserve fertility and preserve fertility in patients.The treatment of late stage cervical cancer advocate a comprehensive treatment of surgery,radiotherapy,chemotherapy.Problems:①Followed up has not been established.②Follow-up rate is low, is difficult to calculate 5-year survival rate.③Surgical method was tradition, surgical improvements lag behind the international trend of minimally invasive.④Strictly controlled clinical staging criteria.⑤Precancerous lesions, the decision of surgical method, adopt rapid surgery pathological examination, and surgical method changes after rapidsurgical pathological examination. |
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