保留卵巢对Ⅰ期子宫内膜样腺癌年轻患者的临床效果观察  

Clinical effect observation on ovarian preservation in young patients with stageⅠendometrioid adenocarcinoma

作　　者：许水清 王明 徐建清 张晶晶 樊蓓[1] 何玥[1] 杨淑丽[1] 王雁[1] 吴玉梅[1] Xu Shuiqing;Wang Ming;Xu Jianqing;Zhang Jingjing;Fan Bei;He Yue;Yang Shuli;Wang Yan;Wu Yumei(Departmentoj Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,China)

机构地区：[1]北京首都医科大学附属北京妇产医院妇瘤科,100006

出　　处：《北京医学》2023年第11期938-942,948,共6页Beijing Medical Journal

摘　　要：目的探讨保留卵巢对Ⅰ期子宫内膜样腺癌年轻患者预后及卵巢功能的影响。方法选取2013年1月至2023年1月首都医科大学附属北京妇产医院初次接受手术的Ⅰ期高/中分化子宫内膜样腺癌患者323例,按照是否双侧切除卵巢分为保留(单/双侧)卵巢组(n=125)和切除(双侧)卵巢组(n=198)。比较两组子宫内膜癌的复发风险,分析保留卵巢组的卵巢功能。结果323例患者年龄21~45岁,平均年龄(39.8±4.6)岁。与切除卵巢组相比,保留卵巢组患者年龄较小、各年龄分布较均匀;病理分期IA(98.40%比92.42%)、高分化程度(66.40%比53.54%)、未进行淋巴结清扫(28.00%比1.01%),术后未辅助治疗(86.40%比84.34%)的比例较高,差异均有统计学意义(P<0.05)。两组的5年无复发率(98.40%比100%)和生存率(100%比100%)的差异无统计学意义(P>0.05)。保留卵巢组发生复发/转移2例(2/125,1.60%),经二次手术后处于持续完全缓解状态。保留卵巢组定期随访的19例患者术后24个月卵巢功能储备良好。结论保留卵巢不影响Ⅰ期子宫内膜样腺癌年轻患者(年龄≤45岁)的预后,且术后卵巢功能良好。Objective To explore the effect of ovarian preservation on the prognosis and ovarian function of young patients with stageⅠendometrioid adenocarcinoma.Methods A total of 323 patients with stageⅠhighly/moderately differentiated endometrioid adenocarcinoma who underwent surgery for the first time in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2013 to January 2023 were selected,and were divided into ovarypreserving(unilateral/bilateral)group(n=125)and ovariectomized(bilateral)group(n=198)according to whether bilateral oophorectomy was performed or not.The recurrence risk of endometrial cancer was compared between the two groups,and the ovarian function of the ovarian preservation group was analyzed.Results The age of 323 patients ranged from 21 to 45 years,with an average age of(39.8±4.6)years.Compared with the ovariectomized group,the patients in the ovary-preserving group were younger and more evenly distributed,the rate of pathological stage IA(98.40%vs.92.42%),high differentiation(66.40%vs.53.54%),no lymph node dissection(28.00%vs.1.01%)and no postoperative adjuvant therapy(86.40%vs.84.34%)were higher,and the differences were statistically significant(all P<0.05).There were no significant differences in the five-year recurrence-free rate(98.40%vs.100%)and survival rate(100%vs.100%)between the two groups(both P>0.05).Recurrence/metastasis occurred in two cases(2/125,1.60%)in the ovary-preserving group,and they were in a state of continuous complete remission after the second operation.A total of nineteen patients in the ovarypreserving group were followed up regularly,and had good ovarian function reserve at good 24 months after operation.Conclusions Preserving the ovary does not affect the prognosis of young patients(age≤45 years)with stageⅠendometrioid adenocarcinoma,and the postoperative ovarian function is good.

关 键 词：子宫内膜癌 卵巢 分子分型 预后 

分 类 号：R737.33[医药卫生—肿瘤]