年轻子宫内膜癌患者保留卵巢功能的可行性分析

Discussion of ovarian preservation for young patients with endometrial carcinoma

目的探讨年轻子宫内膜癌患者行保留卵巢功能手术的可行性。方法回顾性分析广州市番禺中心医院妇产科1998年1月至2008年1月期间经病理检查确诊的235例子宫内膜癌患者的临床病理资料,采用单因素精确概率检验法,研究子宫内膜癌患者发生卵巢转移的高危因素。结果病理类型、子宫病灶大小(>2 cm)、深肌层浸润、CA125水平及腹水癌细胞阳性是发生卵巢转移的高危险因素(P<0.05);患者年龄,宫颈受累,子宫病灶部位与是否发生卵巢转移无明显相关性(P>0.05)。保留单侧或双侧卵巢并未增加年轻患者复发转移的风险(P>0.05)。结论年轻子宫内膜样腺癌患者在进行彻底手术病理分期,确定无卵巢转移高危因素后,可以选择保留卵巢功能,并应对保留卵巢患者严密随访。

Objective To access the feasibility of ovarian preservation in patients with endometrial carcino- ma. Methods The clinicopathological features and outcomes of endometrial carcinoma patients who were diagnosed and treated from Jan. 1998 to Jan. 2008 were retrospectively reviewed and analyzed. Fisher,＇s exact test method was used to determine the high risk factors of ovarian metastasis in patients with endometrial cancer. Results The type of pathology, the size of the tumor（〉2 cm）, the depth of myometfial invasion and the level of the CA125 were the inde- pendent risk factors of ovarian metastasis in these patients （P〈0.05）, but the age, the cervical involvement and the loca- tion of the tumor on the uterus were not the independent risk factors. No increased risk for recurrence and metastasis was found in young patients who preserved ovarian function. Conclusion Hysterectomy with ovarian preservation could be an alternative treatment for young patients with endometfial carcinoma if a thorough surgical staging is con- ducted and no high risk factors of metastasis are present.