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女人子宮頸癌的治療原則及治療手段

出處：網(wǎng)絡收集 日期：2024-07-02 10:02:19 編輯：秩名

子宮頸癌的治療原則是根據(jù)子宮頸癌的分期而定的。而子宮頸癌的分期，部分是基于病理結果，還有一部分則是通過醫(yī)生的體檢確定的。這點與卵巢癌、子宮內(nèi)膜癌等完全通過手術-病理診斷進行分期，是有所不同的。
 
醫(yī)生們建議大家普查出來的癌前病變，如宮頸上皮內(nèi)瘤變（CIN），實際上算不上是癌。即使如CIN III 與原位癌無法區(qū)別，在統(tǒng)計時，原位癌也不列入宮頸癌的統(tǒng)計數(shù)字之內(nèi)。原因很簡單：宮頸癌前病變和原位癌的治療效果太好了，好到與良性疾病無異的地步。這不是在寬慰大家，的的確確是如此。所以，如果有誰在宮頸防癌普查中不幸中槍，被診斷為輕度的上皮內(nèi)瘤（CIN I），千萬別太放在心上。這種情況下，大約有2/3的人，病變會自動消失，僅1/3 的患者，其病變會變成中度上皮內(nèi)瘤變，需要將宮頸的這部分切除，即所謂的宮頸錐形切除。切除之后，大約有8周時間不能同房。等疤痕長好之后，該干嘛就干嘛，對身體基本上沒有什么影響。沒有懷孕的可以懷孕，沒有結婚的可以馬上結婚。當然，每年一次的復查還是要的。
 
重度宮頸上皮內(nèi)瘤與原位癌在顯微鏡下難以鑒別?，F(xiàn)在多數(shù)專家都把這兩個病放在一起進行診斷和處理。其實二者還是有些區(qū)別的，前者稍輕，后者稍重，但這種區(qū)別實在是沒有太大必要。一旦診斷成立，治療上應該行宮頸錐切。有些人把宮頸錐切看成了人生之大不幸，其實沒必要。即使是到了微小浸潤癌時期（即所謂的Ia1期），如果有生育要求，還可以行保留子宮，行宮頸切除術。當然，這得承擔1%的復發(fā)風險。如果沒有生育要求，則建議行子宮切除術。其實，對于這類有兩種或兩種以上選擇方案的人而言，最難做的是醫(yī)生。比如說，對于微小浸潤癌，雖然理論上子宮體已經(jīng)保留了，但很多人并不能正常生育。宮頸保留多少，有時是件難以掌握的事。把宮頸多切點，癌癥復發(fā)的幾率會降低，但生育的幾率也同時降低，從而失去了保留宮頸的意義；把宮頸多保留些，生育的幾率也提高了，但醫(yī)患雙方都怕癌癥復發(fā)。
 
對于Ia2-IIa期宮頸癌而言，現(xiàn)在大家推崇的手術還是經(jīng)典的根治性子宮切除術加盆腔淋巴結切除術。切除的范圍不僅包括子宮，而且需要根據(jù)腫瘤的類型切除部分陰道組織和子宮上的韌帶。從預防癌癥復發(fā)的角度出發(fā)，應該是切得越多越好。至于是使用傳統(tǒng)的方法，還是使用腹腔鏡或者機器人等微創(chuàng)方法進行手術，其實沒有多大的區(qū)別，只是術后恢復時間有所不同。
 
期別較晚的宮頸癌，如宮頸癌IIb期、III期等，都不適宜做手術，應該做放療或者放療加化療。在晚期宮頸癌，放療的效果其實比手術更好。即使是早期宮頸癌，如果選擇放療的話，效果也與手術一樣。不過，放療時由于射線在殺滅腫瘤細胞的同時，也會破壞周圍的組織，如卵巢、腸管、膀胱、尿道等，形成一些難以忍受的并發(fā)癥，如卵巢功能早衰、放射性直腸炎、放射性膀胱炎等，有的患者會感到非常痛苦。如果引起了放射性的直腸陰道瘺、膀胱陰道瘺甚至膀胱-陰道-直腸瘺，生活質(zhì)量會大打折扣。放射線引起來的組織器官瘺，手術很難修復，患者整天生活在尿、糞的浸泡之中，甚至有人失去了對生活的信心。
 
常常有人會問是否該做化療，是否該做放療？這個問題就更加難以用幾句簡單的話回答。比如，有些早期宮頸癌手術后，發(fā)現(xiàn)有脈管浸潤、分化差、或者切緣有癌細胞，或者陽性淋巴結有3枚以上等等，這些都需要化療或者補充放療。有時，是否需要化療或者放療，不是由一兩位專家決定，而是應該由腫瘤內(nèi)科、放療專家和婦科手術醫(yī)師一起，坐下來好好商量。隨著醫(yī)療技術的發(fā)展，一個專家決定生死的時代，已經(jīng)一去不復返了。只有多學科的協(xié)作，才會給予患者一個最佳的治療方案。將患者的利益最大化，將治療的創(chuàng)傷最小化，也是每個醫(yī)生追求的目標。

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