临床Ⅰ期子宫内膜癌患者的卵巢转移问题

Ovarian metastasis in women with clinical stage I endometrial carcinoma.

目的研究临床Ⅰ期子宫内膜癌患者卵巢转移的发生率,以期为年轻内膜癌患者的卵巢保留手术提供依据。方法回顾性收集并分析1994年1月至2002年12月期间在重庆医科大学附属二院妇产科首诊并行手术治疗的子宫内膜癌患者的临床病理资料。结果52例术前诊断为临床Ⅰ期子宫内膜癌患者中,FI-GO手术-病理分期:Ⅰ期47例,Ⅱ期3例,Ⅲ期2例;2例Ⅲ期患者中,1例有子宫浆膜累及,1例有镜下输卵管种植转移,卵巢转移率为3.9%(2/52)。结论高分化及中分化、浅肌层浸润(<1/2)、腹水细胞学阴性、淋巴结无转移的临床Ⅰ期子宫内膜癌患者的卵巢转移的风险较低,这些年轻内膜癌患者是否切除卵巢,尚需在手术标本病理检查后决定。

Objective To explore the incidence of ovarian metastasis in women with clinical stage Ⅰ endometrial carcinoma, in aim to provide surgical evidence of clinical stage Ⅰ endometrial carcinoma in young patients . Methods The pathological and clincal features and outcomes of endometrial carcinoma patients who diagnosed and treated in our hospital from Jan 1994 to Dec 2002 were restrnspectively reviewed and analyzed. Results In fifty - two patients diagnosed as clinical stage Ⅰ endometrial carcinoma , the surgical -pathological stage was Ⅰ in 47patients, Ⅱ in 3 patients, Only two patients were found to be in surgical stage ⅢA. Of these patients,one had uterine serosal involvement and one had a microscopic tumor implant in a fallopian tube; two（3.9% ） had ovarian metastasis. Conclusion The risk of ovarian metastasis in women with well to moderately differentiated endometrial cancer, myometrial invasion limited to less than one half of the myometrium, negative peritoneal cytology and no evidence of metastatic lymph node spread is negligible. Young patients with a preoperative histological diagnosis of well to moderately differentiated endometrial carcinoma may be surgically staged, leaving the final decision regarding removal of the ovaries pending a thorough pathological review of the surgical specimens.