Ⅰ期子宫内膜癌合理术式的探讨

Rational treatment of 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：３８例均行全子宫及双附件切除。按ＦＩＧＯ分期Ⅰ期（Ａ组）经行腹膜后淋巴结清除术２２例，ＦＩＧＯ升级为Ⅲｃ期（Ｂ组）未行腹膜后淋巴结清除的１０例（Ｃ组）。结果：经腹膜后淋巴结清除术的患者中２１．４％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有一定关系（Ｐ＜０．０５和Ｐ＜０．０１）。在平均３０．２个月的随访中，Ａ、Ｂ两组均无瘤生存；Ｃ组中２例肿瘤复发死亡，８例无瘤生存。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 carcinoma.Methods:Thirty eight patients with stage Ⅰ endometrial carcinoma were divided into 3 groups and retrospectively analysed.Twenty two patients by lymphadenectomy were allotted to stage Ⅰ endometrial carcinoma according to FIGO(group A).Six patients were upstaged following lymphadenectomy(group B).Ten patients were staged without lymphadenectomy(group C).Results:21.4%( 6/28 ) of patients were found to have retroperitoneal metastasis and then therefore were upstaged as stage Ⅲc in lymphadenectomy.Metastases were directly related to the differentiation of the tumor,depth of myometrial invasion.During the 30.2 months follow up period,tumor free survival rates in group A and B were 100%( 22/22 ) and 6/6 respectively.In group C,2 patients died from recurrence of the disease,a tumor free survival rate of 8/10.There was a significant difference in tumor free survival rates between group B and C.Conclusions:Retroperitoneal lymphadenectomy should be performed in all patients with stage Ⅰ endometrial carcinoma.