358例子宫内膜癌手术方式及影响预后的危险因素分析  

Surgical Methods and Tumor Recurrence in Endometrial Carcinoma: A Single Institution Review of 358 Cases

作　　者：徐珍[1,2] 彭芝兰[2] 曾俐琴[1] 罗喜平[1] 

机构地区：[1]广东省妇幼保健院,广东广州510010 [2]四川大学华西第二医院,四川成都610041

出　　处：《实用妇产科杂志》2015年第4期274-277,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探讨子宫内膜癌的手术方式及影响预后的危险因素。方法：回顾性分析资料完整、初治为手术治疗并经病理学诊断确诊,且进行系统分期手术的358例子宫内膜癌患者的临床情况及手术方式,并进行随访。对可能影响子宫内膜癌患者预后的危险因素进行分析。结果：358例患者中位发病年龄52岁（20~78岁）,3年总体无瘤生存率分别为Ⅰ期97.12%,Ⅱ期91.67%;Ⅲ期85.19%,复发及死亡14例。开腹手术326例（91.06%）,腹腔镜手术32例（8.94%）。与开腹组手术患者比较,腹腔镜组手术时间较长、平均估计术中失血量较少且平均住院时间短,差异有统计学意义（P〈0.05）。单因素分析表明,有内科合并症、手术病理分期晚、仅行盆腔淋巴结取样、脉管癌栓阳性、盆腔和（或）腹主动脉旁淋巴结转移是影响子宫内膜癌患者预后的危险因素;多因素分析表明,盆腔淋巴结转移是影响子宫内膜癌患者预后的独立危险因素（P=0.000,OR=11.901,95%CI3.291~43.039）。结论：子宫内膜癌以开腹手术为主,腹腔镜手术显示了微创的优势。手术病理分期晚期、伴有内科合并症、仅行盆腔淋巴结取样术、脉管癌栓阳性、腹主动脉旁淋巴结转移,特别是有盆腔淋巴结转移的子宫内膜癌患者预后差。Objective：To determine the surgery options and risk factors to prognosis of endometrial cancer. Methods ：The clinical data of 358 patients with FIGO stage I - IV endometrial cancer who were treated with pri- mary surgery consisting of total hysterectomy, bilateral salpingooophorectomy, pelvic and para aortic lymphade- nectomy and peritoneal cytology were retrospectively analyzed. Follow-up methods were outpatient visit, telephone in all patients. Risk factors for the prognosis of endometrial cancer were analyzed. Results：Among the 358 ca- ses,the median age was 52 years（20 -78 years）. The 3-year disease-free survival were 97. 12% at stage Ⅰ, 91.67% at stage Ⅱ and 85. 19% at stage III, respectively. Abdominal surgery were undertaken in 326 cases （91.06%）, taparosc0Pic surgery were undertaken in 32 cases（8.94% ）. The mean operating time of the laparos- copy group was longer than that of the laparotomy group,the estimated blood loss and time to full recovery of the laparoscopy group was less than that of laparotomy group （all P 〈 0.05 ）. On univariate analysis, surgical-patho- logical stage, complicat!ons, pelvic lymphadenectomy （ sampling or systematic lymphadenectomy）, LVSI, pelvic lymph node counts, pelvic lymph node metastases, and par-aortic lymph node metastases were associated with poor prognosis of endometrial cancer. On multivariate analysis, pelvic lymph node metastasis was an independent risk factor of poor prognosis（ P = 0. 000, OR = 11. 901,95% CI 3. 291 -43. 039）. Conclusions： Laparotomy sur- gery is dominate in. recent years, but laparoscopic surgery as minimally invasive surgical technology is propitious to patients. Endometrial cancer patients who are diagnosed at advanced surgical-pathological stage accompanied by complications, without systematic pelvic lymphadenectomy, positive LVSI, pelvic and （or） para-aortic lymph node metastases tend to have poor prognosis.

关 键 词：子宫内膜癌 盆腔淋巴结转移 复发 腹腔镜手术 

分 类 号：R737.33[医药卫生—肿瘤]