临床Ⅰ期子宫内膜癌的手术切除范围及预后影响因素分析  

Impact of surgical resection extent on the prognosis of clinical stage Ⅰ endometrial carcinoma

作　　者：燕鑫[1] 高雨农[1] 蒋国庆[1] 高敏[1] 安娜[1] 

机构地区：[1]北京大学临床肿瘤学院 北京肿瘤医院暨北京市肿瘤防治研究所妇科 恶性肿瘤发病机制及转化研究教育部重点实验室,100036

出　　处：《中华肿瘤杂志》2009年第3期208-212,共5页Chinese Journal of Oncology

摘　　要：目的探讨临床Ⅰ期子宫内膜癌行不同手术切除范围治疗的临床意义，及其预后影响因素。方法收集135例临床Ⅰ期子宫内膜癌的临床病理资料，其中行全子宫切除＋双附件切除57例（A组），行次广泛或广泛性子宫切除＋双附件切除78例（B组），比较两组患者的临床病理指标，并分析患者预后的影响因素。结果两组患者在手术病理分期、病理类型、病理分级、肌层浸润、脉管癌栓、卵巢浸润、淋巴结转移、腹腔冲洗液细胞学检查以及术后辅助治疗方面，差异均无统计学意义（P〉0．05）。A组中位手术时间为105min，术中中位出血量为150ml，中位输血量为0ml，术后中位住院天数为12d，B组中位手术时间为145min，术中中位出血量为300ml，中位输血量为0ml，术后中位住院天数为13d，两组差异均有统计学意义（均P〈0．05）。A组总的手术并发症发生率为15．8％。B组为26．9％（P〉0．05）。A组复发率为14．0％，B组为6．4％（P〉0．05）。A组5年生存率为76．9％，B组为85．8％（P〉0．05）。多因素分析显示，卵巢是否浸润、腹腔冲洗液是否阳性、病理分级和肌层浸润程度是Ⅰ期子宫内膜癌患者预后的独立影响因素。结论手术切除范围不是影响临床Ⅰ期子宫内膜癌患者预后的重要因素，扩大的手术切除范围并不改善预后，应避免过度手术。Objective To investigate the impact of surgical resection extent and other clinicopathological characteristics on the prognosis in patients with clinical stage Ⅰ endometrial carcinoma. Methods The data of 135 surgically treated patients with clinical stage Ⅰ endometrial carcinoma were retrospectively analyzed. Fifty-seven patients （group A ） underwent simple hysterectomy and salpingo- oophorectomy with or without pelvic lymphadenectomy. The other 78 patients （group B） received sub-radical or radical hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The impact of surgery extent and other clinicopathological characteristics on the prognosis in patients with clinical stage Ⅰ endometrial carcinoma were retrospectively analyzed. Results There were no significant differences between two groups in the pathological stage, pathologic type, tumor grade, depth of myometrial invasion, vascular tumor emboli, ovary invasion, lymph node metastasis, positive peritoneal cytology and adjuvant therapy （P 〉0.05）. However, the patients in group A had a significantly shorter operating time （105 vs. 145 min）, less estimated blood loss （150 vs. 300 ml） and blood transfusion （0 -600 vs. 0 - 1200 ml）, and a shorter postoperative hospital stay （12 vs. 13 days） than that in group B （all P 〈 0.05 ）. The overall rates of post-operative complications were 15.8% in group A versus 26.9% in group B （P 〉 0.05 ）. The recurrence rate in the group A was 14.0% versus 6.4% in group B （ P 〉 0. 05 ）. Furthermore, the five-year survival rate in group A was 76.9% versus 85.8% in group B （P 〉0.05）. Multivariate analysis demonstrated that the important risk factors for clinical stage Ⅰ endometrial carcinoma were deep myometrium invasion, high pathological grade, positive peritoneal cytology and ovarian metastasis, rather than surgical resection extent. Conclusion Surgery extent is not an important factor affecting the prognosis in patients with clinical stage Ⅰ endom

关 键 词：子宫内膜肿瘤 手术切除范围 预后 

分 类 号：R686[医药卫生—骨科学]