临床拟诊Ⅰ期的年轻子宫内膜癌患者保留卵巢的探讨

Investigation of Ovarian Preservation in Young Patients With Endometrial Carcinoma of Clinical StageⅠ

目的分析临床拟诊为Ⅰ期子宫内膜癌年轻患者的附件转移情况,初步探讨年轻子宫内膜癌患者保留卵巢的可行性。方法收集2000年1月至2009年12月本院妇科收治的74例年龄为30～70岁临床拟诊为Ⅰ期子宫内膜癌患者的病历资料,采用回顾性分析法探讨子宫内膜癌的病理学类型、组织学分级、肌层浸润深度、淋巴结转移情况等与临床拟诊为Ⅰ期子宫内膜癌年轻患者的附件转移关系。所有患者均进行手术病理学分期(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会审查和批准)。结果临床拟诊为Ⅰ期子宫内膜癌的年轻患者中,术后病理学类型中内膜样腺癌、腺鳞癌的附件转移发生率比较,差异无显著意义(P>0.05);组织学间的附件转移发生率比较,差异有显著意义(P<0.01);肌层浸润深度间附件转移发生率比较,差异有显著意义(P<0.01);有淋巴结转移和无淋巴结转移者的附件转移发生率无法比较;腹水细胞学检查呈阳性与阴性的附件转移发生率比较,差异无显著意义(P>0.05)。结论对早期子宫内膜癌年轻患者手术治疗中是否保留卵巢,应慎重处理。若肿瘤细胞为高分化、无肌层浸润,可考虑在充分探查分期手术的基础上,切除近病灶侧卵巢而保留对侧卵巢。

Objective To investigate the approach of ovarian preservation by analyzing the retrospective data of adnexal metastasis in young patients with endometrial carcinoma of clinical stage Ⅰ Methods The pathological type, histological grade, depth of myometrial invasion, lymph node metastasis and adnexal metastasis in endometrial carcinoma patients who were clinically diagnosed stage Ⅰ and treated from January 2000 to December 2009 in the department of Obstetrics and Gynecology, Third Affiliated Hospital, SUN Yat-sen University were retrospectively reviewed and analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Third Affiliated Hospital, SUN Yat-sen University. Informed consent was obtained from all participants. Results There had no significant difference in the rate of adnexal metastasis between endometrioid adenocarcinoma and adenosquamous carcinoma （P〉0.05）. There was significantly statistics difference in the rate of adnexal metastasis among the histological grades of G1 and G2 （P^O. 01）, and also significantly different among the non-myometrial invasion, superficial myometrial invasion and deep myometrial invasion （P〈0. 01）. With lymph node metastasis and without lymph node metastasis rate of adnexal metastasis can not be compared. Conclusion Adnexal metastasis was related with histological grade and depth of myometrial invasion in the patients with endometrial carcinoma clinically diagnosed stage Ⅰ. The ovary may be preserved cautiously in young endometrial carcinoma patients with histological G1 and non-myometrial invasion.