肿瘤细胞减灭术治疗晚期子宫内膜癌的临床观察

Clinical study of cytoreductive surgery in advanced endometrial carcinoma

为了探讨肿瘤细胞减灭术在晚期子宫内膜癌治疗中的应用价值,对我院住院行肿瘤细胞减灭术的36例晚期子宫内膜癌患者临床资料进行回顾性分析。Ⅲ期16例,Ⅳ期20例。所有患者均给予以手术治疗为主的综合治疗,基本手术方式为全子宫+双附件+大网膜阑尾切除及盆腹腔内转移病灶切除。结果:本组肉眼无残余病灶者10例,残余病灶<2cm者20例,残余病灶>2cm者6例,手术满意率为83.3%(30/36)。随访至2007-12,5年生存率仅为31.3%(5/16),3年生存率为54.2%(13/24),1年生存率为91.7%(33/36)。生存率与患者病变侵及范围、有无腹水、手术后残留病灶大小以及术后化疗周期长短等密切相关。初步研究结果提示,肿瘤细胞减灭术在晚期子宫内膜癌治疗中有重要价值,提倡最大限度切除病灶减少肿瘤负荷,在理想的肿瘤细胞减灭术的基础上给予多疗程的联合化疗,而放射治疗的意义不大。

The objective of this study was to observe the clinical value of cytoreductive surgery in advanced endometiral cacinoma. A retrospective study was performed in 36 cases of advanced endometrial carcinoma who received cytoreduetive surgery. All the patients including 16 cases of stage Ⅲ and 20 cases of stage Ⅳ were treated with combined therapy based on operation. The basic method included total hysterectomy, both adnexectomy, omentectomy, appendectomy and resection of metastatic lesion in ahdominopelvic cavity. The content rate of operation was 83.3% （30/36）, including 10 cases of no unaided eye residual focus, 20 cases of residual focus smaller than 2 cm and 6 cases of residual focus larger than 2 cm. To December 2007, the survival rates of 5 year, 3-year and 1-year were 31.3 （5/16）, 54.2%（13/24） and 91.7%（33/36）, respectively. The survival rate intimately correlated with the extent of disease, ascites, size of residual focus, circles of chemotherapy after the operation. In conclusion, cytoreductive surgery has an important value in advanced endometiral cacinoma. Multi-circle combined chemotherapy based on ideal cytoreductive surgery is effective, while radiotherapy has no furlher therapeutic effect.