年轻子宫内膜癌患者保留生育功能的风险评估  

Risk evaluation of fertility-sparing therapy in young women with endometrial carcinoma

作　　者：邓凤[1] 彭芝兰[1] 吕琳[1] 郭娜[1] 

机构地区：[1]四川大学华西第二医院,四川成都610041

出　　处：《现代预防医学》2013年第1期32-34,37,共4页Modern Preventive Medicine

摘　　要：目的分析年轻子宫内膜癌患者临床病理特点,探讨其保留生育功能的风险及安全性评估。方法回顾某院2004年1月～2007年6月住院手术治疗且≤45岁的原发子宫内膜癌患者104例,总结其临床病理特点。结果 (1)≤45岁子宫内膜样腺癌与非子宫内膜样癌相比,两者在分化级别、肌层浸润、宫颈侵犯、脉管癌栓、卵巢转移、淋巴结转移等差异有统计学意义(P﹤0.05),且高分化患者均无宫颈侵犯及宫外转移。(2)术前诊刮为子宫内膜样腺癌者88例,96.6%患者与术后病理类型相符,30.4%的高分化患者被低估了分化级别。(3)临床I期87例年轻患者中,5.7%术后分期上升。高分化或者无肌层浸润患者均无宫颈侵犯、脉管癌栓、淋巴结及卵巢转移。结论≤45岁的高分化子宫内膜样腺癌患者临床病理上表现为低危性特征,这为保留生育功能创造了可行性。但术前诊刮低估了分化级别,临床分期存在误差,治疗存在较多风险。如何选择合适的病例及准确评估风险,是今后保留生育功能治疗研究的重点之一。OBJECTIVE To analyze the clinical-pathologic characteristic of young women with endometrial carcinoma, and to evaluate the safety of fertility-sparing therapy. METHODS Clinical and pathological data of 104 patients with endometrial carci- noma surgically treated in this hospital from January 2004 to June 2007 were retrospectively reviewed. RESULTS （ 1 ） There were statistical differences between endometrioid adenocarcinoma （EA） and non EA at histological grade, myometrial invasion, cervical invasion, LVSI, ovarian and lymphatic metastasis, P 〈 0.05. And none of G1 ones were with cervical invasion and ex- tra-uterine metastasis. （2） There were 88 EA diagnosed by dilatation and curettage （D＆C）, 96.6% of which were in accor- dance with surgical pathological types. But, the grades of 30.4% patients with G1 EA were underestimated. （3） 5.7% of 87 pa- tients in clinical stage I were proved to be in higher surgical-pathological stages. All of patients with G1 or without myometrial invasion were without cervical invasion and extra-uterine metastasis. CONCLUSION Young GI EA patients （~〈45years） are with low risk clinical-pathologic characters. This gives rise to the feasibility of fertility-sparing therapy. The D＆C might underes- timate the histologic grades. And the clinical stages exist errors. Because kinds of risk, we should give the strict indications for fertility-sparing therapy and do the best to assess the risks.

关 键 词：子宫内膜癌 年轻 保留生育功能 风险 

分 类 号：R737.33[医药卫生—肿瘤]