年龄≤40岁Ⅰ期子宫内膜癌患者保留卵巢的临床分析  

Clinical analysis of ovarian preservation for stageⅠendometrial carcinomas in women aged 40 years and younger

作　　者：李林[1] 吴令英[1] 张蓉[1] 张功逸[1] 李宁 李晓光[1] 袁光文[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所妇瘤科,100021

出　　处：《中华妇产科杂志》2014年第4期260-264,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨年龄≤40岁Ⅰ期子宫内膜癌患者保留卵巢的安全性。方法回顾性分析中国医学科学院肿瘤医院1999年1月至2012年1月收治的75例年龄≤40岁的Ⅰ期子宫内膜癌患者的临床病理资料，根据术中是否保留卵巢分为保留卵巢组（20例）及切除卵巢组（55例），比较分析两组的临床病理特征及预后。结果保留卵巢组中13例患者保留双侧卵巢、7例保留单侧卵巢。保留卵巢组与切除卵巢组在发病年龄、体质指数、手术病理分期、病理类型、病理分级、腹水或腹腔冲洗液细胞学结果及术后治疗方式等方面比较，差异均无统计学意义（ P＞0.05）；而术前血CA125水平升高保留卵巢组有5例（25％，5／20），切除卵巢组为10例（18％，10／55），两组比较，差异有统计学意义（P＝0.029）。切除卵巢组行盆腔淋巴结切除或活检术的比例显著高于保留卵巢组[分别为35％（7／20）、84％（46／55）]，两组比较，差异有统计学意义（P＜0.01）。75例患者的中位随诊时间为31.7个月（0～160个月），共有2例患者复发。保留卵巢组与切除卵巢组患者5年总生存率（分别为100.0％、100.0％）和5年无瘤生存率（分别为90.0％、95.5％）比较，差异无统计学意义（ P＝0.579）。结论保留卵巢对年轻Ⅰa期、分化好的子宫内膜样腺癌患者的生存无显著影响。对此类患者保留卵巢的安全性仍需大规模前瞻性临床研究进一步证实。Objective To investigate the safety of ovarian preservation for stage Ⅰ endometrial carcinomas in women aged 40 years and younger.Methods Seventy-five cases of stage Ⅰ endometrial cancer aged 40 years and younger from Jan 1999 to Jan 2012 were treated in Cancer Hospital , Chinese Academy of Medical Sciences.They were further divided into two groups：20 patients who underwent ovarian preservation （group A） and 55 patients who underwent oophorectomy （group B）.Clinical and pathological recordings of these patients were reviewed and compared.Results In the group A , there were 13 patients preserved both ovaries , and 7 patients preserved a single ovary.While there were no significant differences in the age, body mass index, surgical staging, histology, grade, cytology of peritoneal lavage or ascites , and postoperative treatment between two groups （ all P＆gt;0.05 ）.The differences in the level of CA 125 [ 25%（5/20） versus 18%（10/55）] and number of patients underwent pelvic lymphadenectomy [35% （7/20） versus 84%（46/55）] were statistically significant between two groups （all P〈0.05）.Of seventy-five cases, only two patients relapsed and all survived after a median follow-up time of 31.7 months （ range：0 to 160 months）.Kaplan-Meier analysis revealed no difference in overall survival （100.0% versus 100.0%） and disease free survival （ 90.0% versus 95.5%） between two groups （ P =0.579 ）.Conclusions Ovarian preservation has no statistically significant impact on the survival of young patients with stage Ⅰa, well differentiated endometrial cancer.Large-scale, prospective clinical studies are needed to validate the safety of ovarian preservation for those patients.

关 键 词：子宫内膜肿瘤 卵巢 妇科外科手术 预后 发病年龄 保留生育能力 

分 类 号：R737.33[医药卫生—肿瘤]