子宫内膜癌手术范围的前瞻性临床研究

TheProspectiveStudyontheScopeofExtendedOperationforEndometrialCarcinoma

目的：探讨子宫内膜癌的适宜手术范围。方法：对１０５例子宫内膜癌患者施行广泛性或次广泛性子宫切除术加盆腔及（或）主动脉旁淋巴清扫术；另对３６例子宫内膜癌患者仅作次广泛性子宫切除术。对本组１４１例的手术切除标本，包括宫旁结缔组织及淋巴结、盆腔及主动脉旁淋巴结等进行病理学检查。结果：１０５例中，盆腔淋巴结发生转移１９例，占１８．１０％。除Ⅰａ期外，余各期均有淋巴结转移发生。Ⅰｂ、Ⅰｃ期淋巴结转移率分别为８．８２％与２１．０５％。１４１例行广泛性与次广泛性子宫切除术者中，宫旁结缔组织转移２例（Ⅱ、Ⅲｂ期）；宫旁淋巴结转移２例（Ⅰｃ、Ⅲｂ期）；宫旁血管瘤栓２例（Ⅰｂ、Ⅰｃ期）。结论：除Ⅰａ期以外的其他各期，均宜施行广泛性或次广泛性子宫切除术，以及盆腔或主动脉旁淋巴清扫术。

Objective:Toinvestigatethescopeofextendedoperationforendometrialcarcinoma.Methods:105patientsunderwentextendedorlessextendedhysterectomypluspelvicand/orpara-aorticlymphadenectomyand36patientsunderwentlesradicalhysterectomyonly.Prospectiveinves-tigationofthese141casesofendometrialcarcinomawasundertaken.Results:Ofthe105cases,lymphnodemetastasis(18.10%)occurredin19cases.MetastasiswerefoundinalstagesexceptstageIa.TheincidencesoflymphnodemetastasisinstageIbandstageIcwere8.82%and21.05%respectively.Ofthe141casesofextendedorlessextentedhysteretomy,2werewithparametrialconnectivetissuemetastasis(stageⅡandstageⅢb),2withparametriallymphnodemetastasis(stageⅠcandstageⅢb)and2withparametrialvascularinvolvement(stageⅠbandstageⅠc).Conclusions:TheextendedorlessextendedhysterectomyandlymphadenectomyshouldbeperformedinalpatientsofendometrialcarcinomaexceptthoseofstageⅠa.