Ⅰ期子宫内膜癌腹膜后淋巴结清除术的探讨

The Resection of Retroperitoneal Pelvic and Para-aortic Lymph nodes in Stage I Endometrial Carcinoma

目的探讨Ⅰ期子宫内膜癌的淋巴结转移率及行腹膜后淋巴结清除术的意义。方法对３８例临床Ⅰ期子宫内膜癌患者临床、病理及随访资料进行回顾性研究，对照分析经行腹膜后淋巴清除术后，未发现淋巴转移者２２例，ＦＩＧＯⅠ期（Ａ组），有淋巴结转移者６例，ＦＩＧＯ升级为Ⅲｃ期（Ｂ组）及未行腹膜后淋巴清除的１０例（Ｃ组）。结果经腹膜后淋巴清除术的患者中２１４％（６／２８）有腹膜后淋巴结转移，因此期别应上升为Ⅲｃ期，且腹膜后淋巴结转移与肿瘤细胞分级及肌层浸润深度相关（Ｐ＜００５）。在平均３０２个月的随访中，Ａ、Ｂ两组无瘤生存率均为１０００％（２２／２２及６／６），Ｃ组中２例肿瘤复发死亡。无瘤生存率为８００％（８／１０），比较有淋巴结转移的Ｂ组６例及Ｃ组中２例的生存率，差异有显著性（Ｐ＜００５）。结论对临床分期为Ⅰ期的子宫内膜癌患者应常规行全子宫、双附件切除加腹膜后淋巴结清除术。

Objective To evaluate the incidence of lymph node metastasis and significance of lymphadenectomy in stage I endometrial cancinoma. Metholds 38 patients with stage I endometrial carcinoma were divided into 3 groups and retrospectively analysed.22 patients by lymphadenectomy were allotted to stage I endometrial carcinoma according to FIGO(group A).6 patients were upstaged following lymphadenectomy(groug B).And 10 patients were staged without lymphadenectomy(group C). Results 214%(6/28)of patients were found to have retroperitoneal metastasis and therefore were upstaged as stage c by lymphadenectomy.Metastases were directily related to the differentiation of the tumor,depth of myometrial invasion.During the 302 months follow-up period,tumor-free survival rates in group A and B were both 100%(22/22 and 6/6 respectively),In group C,there were 2 recurrent patients and died of the diseases.The tumor-free survival rate was 80%(8/10).There was a significant difference in tumor-free survival rate between group B and C. Conclusions Retroperitoneal lymphadenectomy should be performed in all patients with stage I endometrial carcinoma.