淋巴结清扫术在Ⅰ期子宫内膜癌中的意义

The significance of lymphadenectomy in stage Ⅰ endometrial carcinoma

目的 探讨盆腔淋巴结清扫术在Ⅰ期子宫内膜癌中的临床意义。方法 回顾性分析 1990年 1月～ 2 0 0 0年 12月 ,在我院住院治疗的Ⅰ期子宫内膜癌 112例 ,其中广泛或次广泛子宫切除术加盆腔淋巴结清扫术 6 6例 ,单纯广泛或次广泛子宫切除术 4 6例。结果 在 6 6例Ⅰ期子宫内膜癌中 ,发现 7例淋巴结转移 ,转移率为 10 6 %。Ⅰa期中无淋巴结转移 ;Ⅰb期转移率为 5 9% (2 34) ;Ⅰc期转移率为 2 5 % (5 2 0 )。Ⅰ期子宫内膜癌随着肌层浸润的加深其淋巴结转移率亦增加 ,P <0 0 5。而且特殊类型的子宫内膜癌其淋巴结转移率明显高于腺癌。但是行淋巴结清扫术与未行淋巴结清扫术的 5年生存率无差异。结论 Ⅰa期可以不做淋巴结清扫术 ,Ⅰc期和合并高危因素的Ⅰb期必须行盆腹腔淋巴结清扫术。且加强术前术中对肌层浸润程度的判断 ,以指导Ⅰ期亚分期的确定。淋巴结清扫术本身能否改善Ⅰ期患者的预后有待进一步研究。

Objective To explore the clinical significance of pelvic lymphadenectomy in stage Ⅰ endometrial carcinoma. Methods From 1990 to 2000, 112 patients with stage Ⅰ endometrial carcinoma undergoing surgical treatment in our hospital were studied retrospectively, including 66 with radical or modified radical hysterectomy and pelvic lymphadenectomy and 46 with radical or modified radical hysterectomy only. Results Among the 66 patients, 7 were found to have lymph node metastasis(10.6%), with 0%(0/12), 5.9%(2/34)and 25%(5/20) for stageⅠa?stageⅠb and stageⅠc respectively.The positive node rate increased with depth of myoinvasion(P<0.05).The lymph node metastasis rate in special types of endometrial carcinoma was higher than that in adenocarcinoma.No significant difference in the 5-year survival rate was found between cases with lymphadenectomy and without lymphadenectomy. Conclusions The lymphadenectomy was not needed in stage Ⅰa endometrial carcinoma, yet necessary for stageⅠc and stageⅠb with high risk factors.Whether lymphadenectomy affects prognosis of stage Ⅰ endometrial carcinoma requires further study.