年轻子宫内膜癌患者术中卵巢去留问题探讨

Discussion of ovarian resection problem in young endometrial carcinoma patients

目的回顾性分析子宫内膜癌患者卵巢转移的情况，初步探讨年轻子宫内膜癌患者手术治疗中卵巢去留问题。方法对2000年12月至2004年12月间中山大学附属第三医院、中山大学附属第二医院及中山大学附属肿瘤医院妇科收治的189例子宫内膜癌病例进行回顾性分析，探讨年龄、病理类型、组织学分级、肌层浸润深度、淋巴转移等与附件转移的关系。结果组织学分级G1、G2、G3的附件转移发生率分别是O％、19．5％、34．4％，三者比较有显著的统计学差异（P〈0．01）；无肌层浸润、浅肌层浸润、深肌层浸润的附件转移发生率分别为6．3％、10．4％、39．6％，三者比较有显著的统计学差异（P〈0．01）；有淋巴转移者与无淋巴转移者的附件转移发生率为63．0％、9．9％，两者比较有显著的统计学差异（P〈0．01）。进行多因素logistic回归分析，结果只有组织学分级及淋巴转移与否引起附件转移的差异有统计学意义（P〈0．01）。结论附件转移与组织学低分化、深肌层浸润或伴有淋巴结转移相关，组织学低分化、淋巴转移更是附件转移的独立高危因素。对无合并附件转移高危因素的年轻早期患者可考虑保留远离癌灶侧卵巢。

Objective To analyze ovarian metastasis of patients with endometrial carcinoma and to discuss whether to keep the ovarian or not during the surgical treatment of young patients. Methods 189 cases of endometrial carcinoma accepted from Dec. 2000 to Dec. 2004 were analyzed restropectively and the relationship between ages, pathology types, histology grades, muscular layer infiltration degrees, lymphatic metastasis and attachments metastasis. Results Attachments metastasis rates of histology grade 1 （ G1 ）, grade 2 （ G2 ） and grade 3 （ G3 ） were 0%, 19.5 % and 34.4% respectively and they had significant difference （P 〈 0.01 ）. Rates of non-muscular layer infiltration, shallow infiltration and deep infitration were 6.3%, 10.4% and 39.6% and they had significant difference （P 〈 0.01 ）. Rates of lymphatic metastasis and non-lymphatic metastasis were 63. 0% and 9.9% and they had significant difference （ P 〈 0.01 ）. Mutiple factors Logistic regression analysis showed that difference of attachment metastasis was significant, only relating to the occurance or not occurance of histology grade and lymphic metastasis（ P 〈 0.01 ）. Conclusion Attacement metastasis was related to histology grades, muscular layer infiltration degrees and lymphatic metastasis, of which histoloy grade and lymphic metastasis were its independent and high-risk factors. For the young patients comnined with high-risk factors of attachment metastasis, we should consider to keep the ovarian far away from the cancer.