盆腔淋巴结清扫术用于子宫内膜癌治疗的探讨

Place of Value of Pelvic Lymphadenectomy for Treatment of Endometrial Neoplasms

目的 探讨盆腔淋巴结清扫术 (清扫术 )对子宫内膜癌治疗的作用。方法 分析行清扫术者 10 4例 ,分别比较各种临床病理因素的盆腔淋巴结转移发生率 ,淋巴结行清扫术与非清扫术的 5年生存率。结果 临床Ⅰ期子宫内膜癌患者的盆腔淋巴结转移率为 4.4%。深肌层浸润及低分化癌(G3 )的盆腔淋巴结转移率升高 ,分别为 37.3%及 37.8%。临床Ⅰ、Ⅱ期患者盆腔淋巴结转移与非转移的 5年生存率分别为 38.9%及 74.2 % ,差异有显著性 (P <0 .0 0 5 )。病理Ⅰ、Ⅱ期行淋巴结清扫术与非淋巴结清扫术患者的 5年生存率分别为 73.1%及 82 .9% ,差异无显著性 (P >0 .0 5 )。结论 盆腔淋巴结转移是子宫内膜癌患者的重要预后因素 ,淋巴结清扫术本身不能改善早期患者的预后。Ⅰ期低危者盆腔淋巴结转移率甚低 ,不需施行清扫术。

Objective To explore the therapeutic value of pelvic lymphadenectomy for endometrial carcinoma. Methods One hundred and four cases undergoing pelvic lymphadenectomy were analyzed. Comparisons were carried out between various clinicopathologic factors and incidence of positive node, between 5 years survival rate with pelvic lymphadenectomy and that without pelvic lymphadenectomy. Results Four point four per cent case with positive node was found in clinical stage Ⅰ cases. Positive node rate increased with deep myoinvasion and G 3, accounting for 37.3% and 37.8% respectively. For clinical stage Ⅰ and stage Ⅱ cases, the 5 year survival rate of positive node and negative node was 38.9% and 74.2% respectively, with significant difference ( P <0.005). No significant difference was found between cases with pelvic lymphadenectomy and those without pelvic lymphadenectomy ( P >0.05) in pathologic stage Ⅰ and stage Ⅱ cases. Conclusions Positive pelvic node is an important prognostic factor in endometrial carcinoma. Pelvic lymphadenectomy can not improve prognosis in early stage patients with endometrial carcinoma. It is not necessary to perform pelvic lymphadenectomy for stage Ⅰ case, because of low incidence of positive node.