不同手术方式对Ⅰ期子宫内膜癌患者的预后分析  

Analysis of different operations for early stage endometrial cancer

作　　者：李菁[1] 吴步初[1] 龙雯晴[1] 狄文 

机构地区：[1]上海交通大学医学院附属瑞金医院妇科,200025

出　　处：《中国妇产科临床杂志》2017年第5期392-394,共3页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的总结分析不同手术方式对Ⅰ期子宫内膜癌患者的预后,以选择最佳的外科治疗方式。方法回顾性分析上海交通大学医学院附属瑞金医院1995年1月至2008年3月收治的子宫内膜癌患者98例,术前诊断为Ⅰ期。根据手术方式分为两组,A组68例行全子宫双附件切除,B组30例行全子宫双附件切除+盆腔腹主动脉旁淋巴结清扫术,术后随访96~254个月。结果 98例随访率100%。93例最终分期为Ⅰ期的内膜癌病例中,A组5年无瘤生存率88.2%,B组84.0%;术后复发10例(10.8%),其中A组7例,B组3例,两组比较差异无统计学意义(P>0.05)。复发者为ⅠA(<1/2肌层)G2(肿瘤>2 cm)、ⅠB G2、ⅠB G3,及非子宫内膜样腺癌。淋巴结清扫组5例分期上升为ⅢC期,预后不佳。结论对于早期子宫内膜腺癌(ⅠA期),肿瘤细胞分化良好(G1~G2),且无相关高危因素的患者,单纯行全子宫双附件切除术是最佳治疗方案。Objective To analyze the different operations of early stage endometrial cancer, in order to choose the best surgical treatment for this disease. Methods The clinical data of 98 cases of endometrial carcinoma treated in our hospital between January 1995 and March 2008 were retrospectively analyzed. All of the patients were preoperative stage I, and pathologically diagnosed by preoperative curettage or hysteroscopy. There was no metastasis detected in the abdomen/pelvic cavity or lymph nodes outside the uterus. These 93 cases were divided into two groups according to the surgical treatment they received. Group A （68 cases） was only treated with regular hysterectomy and bilateral salpingo- oophorectomy. Group B （30 cases） received regular hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection. Patients were followed up for 96~254 months. Results The follow up rate was 100%. In stage I patients （93 cases）, the 5-year disease-free survival rate was 88.2% in group A, and 84.0% in group B; 10 cases （10.8%） with recurrences at the end of follow-up （7 in group A and 3 in group B,P 〉 0.05）. The 10 cases were stage Ⅰ A（ 〈 1/2 muscular invasive）/G2 （tumor size 〉 2 cm）, stage Ⅰ B/G2, stage Ⅰ B/G3, or non-adenocarcinoma. 5 cases in group B were up-graded to stage Ⅲ C, and they had a poor prognosis. Conclusion For patients with early stage （ Ⅰ A） endometrial adenocarcinoma and good cell differentiation （G1-G2） without other high risk factors, regular hysterectomy and bilateral salpingo-oophorectomy are optimal treatment.

关 键 词：子宫内膜癌 全子宫双附件切除术 盆腔腹主动脉旁淋巴结清扫 

分 类 号：R737.33[医药卫生—肿瘤]