Ⅰ期子宫内膜癌患者的循证治疗方案

Evidence-based treatment plan for a patient with stage Ⅰ endometrial cancer

目的通过一例Ⅰ期子宫内膜癌患者的手术方式及是否需要行盆腔淋巴结清扫的问题,检索当前最佳临床证据,针对患者具体情况为治疗提供依据。方法根据循证医学的PICO原则,提出问题,检索证据,对所获证据进行质量评价,并结合患者具体情况制定治疗方案。结果共纳入中、英文文献138篇,2个随机对照试验和3篇临床指南。证据结果表明:对于Ⅰ期子宫内膜癌的手术方式及手术范围,目前并无大宗RCT提供证据,综合指南推荐、文献报道、临床经验及患者具体情况,该名患者手术方式目前仍推荐用腹式,并行盆腔淋巴结清扫术。结论对于Ⅰ期子宫内膜癌的手术方式及范围,目前并无强有力的证据支持,需要遵循循证医学的原则,综合各方面因素考虑。

Objective To study an evidence-based treatment plan for a patient with stage Ⅰ endometrial cancer.Methods According to the PICO（patient intervention comparison outcome） principle,the questions were introduced and the evidences were collected and critically assessed.The specific conditions of the patient were also taken into consideration to design the treatment plan.Results 138 Chinese and English articles,2 random control trials and 3 clinical guidelines were involved.The collective evidences indicated that there were no RCT to provide evidences about the type and scope of surgery for stage Ⅰ endometrial cancer.According to the treatment guidelines,article reports,clinical experience and the specific condition of the patient,laparoto-mic surgery and pelvic lymphadenectomy for this patient was recommended.Conclusion There are no strong evidences for the type and scope of surgery for stage Ⅰ endometrial cancer.Under the principle of evidence-based medicine,all aspects should be taken into consideration in the decision of treatment.