子宫内膜癌新旧分期的临床比较  

Old and new staging of endometrial carcinoma

作　　者：赵玲利[1] 何晓音[1] 

机构地区：[1]浙江萧山医院妇科,杭州311201

出　　处：《中华医学杂志》2012年第23期1612-1614,共3页National Medical Journal of China

摘　　要：目的探讨子宫内膜癌新旧手术病理分期治疗合理性及临床意义。方法对浙江萧山医院2005年6月至2011年6月收治的92例子宫内膜癌患者（年龄35—78岁）临床与预后随访资料进行回顾分析，并重新进行新旧手术病理分期，观察其分期合理性及治疗预后。结果92例术后旧分期为：Ⅰ期67例（72．8％），Ⅱ期7例（7．6％），Ⅲ期18例（19．6％）。新分期Ⅰ期79例（85．9％），Ⅱ期3例（3．3％），Ⅲ期10例（10．9％）。术中腹腔液常规细胞学阳性检出率为8．7％（8／92），盆腔淋巴结阳性率12．9％（11／85）。术后3及5年ⅠA、ⅠB、ⅡA期生存率比较差异无统计学意义，P〉0．05；而ⅠB期与ⅠC期比较差异有统计学意义，P〈0．05，深肌层浸润生存率显著短于浅肌层。腹主动脉淋巴结阳性率3．8％（1／26），6例淋巴结阳性者分别于术后4—28个月内死于癌症。结论子宫内膜癌新分期较1988年的旧分期更加客观、实用，也更简便。子宫内膜癌深肌层及淋巴阳性是影响预后的重要因素。早期低危子宫内膜癌淋巴结阳性率低，常规淋巴结切除意义不大。Objective To explore the rationality and clinical significance for the old and new surgical-pathological staging in endometrial carcinoma. Methods The clinical profiles and prognostic particulars were analyzed retrospectively in 92 cases of endometrial carcinoma from June 2005 to June 2011 at Xiaoshan Hospital. And the old and new surgical-pathological staging methods were applied to observe their rationality and treatment prognosis. Results There was 72. 8% （67/92） for clinical stage Ⅰ in the old surgical-pathological staging while 7.6% （7/92） for clinical stage Ⅱ and 19.7% （18/92） for clinical stage Ⅲ. There was 85.9% （79/92） for clinical stage Ⅰ in the new surgical-pathological staging, 3.3% （3/92） for clinical stage Ⅱ and 10. 7% （10/92） for clinical stage Ⅲ. The detection rate of cancer cell was 8.7% （8/92） in peritoneal fluid. The positive rate of pelvic lymph node was 12. 9% （11/85 ）. A period of survival rates were compared among P 〉 0. 05 after 3 years and 5 years of Ⅰ A, Ⅰ B and Ⅱ A. There was no statistical significance ; there were statistical significance between Ⅰ B and Ⅰ C periods （P 〈 0. 05 ）. The survival of deep myometrial invasion was significantly shorter than that of superficial muscle layer. The positive rate of abdominal aortic lymph node was 3.8% （1/26）. Six patients with positive lymph nodes died postoperatively of cancer within 4 to 28 months. Conclusion The new surgical-pathological staging is more objective, practical, simple and convenient than its old counterpart. Deep myometrial infiltration and positive lymph node are important prognostic factors of endometrial carcinoma. The positive rate of lymph node remains low in early low-risk endometrial carcinoma and routine excision of lymph node is of little significance.

关 键 词：子宫内膜肿瘤 肿瘤分期 

分 类 号：R737.33[医药卫生—肿瘤]