不同手术方式对Ⅰ期子宫内膜癌患者生存及复发的影响

Influence of surgical methods on survival and recurrence of stage Ⅰ endometrial carcinoma

目的 了解不同手术方式对Ⅰ期子宫内膜癌患者术后生存及复发的影响。方法 回顾性分析 1986～ 1996年行手术治疗的Ⅰ期子宫内膜癌患者 110例 ,根据手术方式不同将其分为 3组 ,行全子宫 +双侧附件切除术者为A组 (5 4例 ) ;行广泛或次广泛性全子宫切除术者为B组 (14例 ) ;行全子宫 +双侧附件切除 (或广泛性全子宫切除或次广泛全子宫切除 ) +盆腔淋巴结清扫术者为C组 (4 2例 ) ,分析 3组的生存和复发情况。结果 A、B、C 3组的 5年生存率分别为 89 5 %、90 5 %、95 1% ,3组间比较 ,差异无显著性 (P >0 0 5 )。随诊超过 2年的 71例中 9例复发 ,复发率为 12 7% ;9例复发者中 7例于 3年内复发 ,其中盆腔局部复发 8例 ,远处转移 5例 ;A、B、C 3组的复发率分别为 13 9%、9 1%、12 5 % ,其中盆腔局部复发率分别为 13 9%、9 1%、8 3% ,远处转移率分别为 2 8%、9 1%、12 5 % ,分别比较 ,差异均无显著性 (P >0 0 5 )。结论 手术方式不是影响Ⅰ期子宫内膜癌患者生存率的主要因素 ,扩大手术范围或行淋巴结清扫术并不能显著提高患者的生存率。远处转移在术后复发患者中占有相当的比例 ,辅助治疗时应考虑术后复发的这种特点。

Objective To determine the influence of different surgical procedure on post operative survival rate and recurrence of stage Ⅰ endometrial carcinoma Methods From 1986 to 1996, 110 patients with stage Ⅰ endometrial carcinoma surgically treated in our hospital were studied retrospectively They were devided into three groups, including total hysterectomy plus bilateral salpingo oophorectomy (group A), radical or modified radical hysterectomy (group B) and total hysterectomy plus bilateral salpingo oophorectomy or radical hysterectomy or modified radical hysterectomy+pelvic lymphadenectomy (group C) Survival and recurrent rates were analysed according to thefollow up data Results Five year survival rate of the three groups are 89 5%, 90 5% and 95 1% respectively( P >0 05) Of the 71 cases followed up for more than two years, 9 relapsed The recurrent rates were 12 7% Seven relapsed within three years after operation Eight patients had local recurrence and 5 had distant metastasis Recurrent rates of three groups are 13 9%, 9 1% and 12 5% ( P >0 05), local recurrent rates are 13 9%, 9 1% and 8 3% ( P >0 05), distant metastasis rates are 2 8%, 9 1% and 12 5% respectively ( P >0 05) with no statistical significance Conclusions Surgical method is not the main factor influenced the survive of stage Ⅰ endometrial carcinoma Radical operation or lymphadenectomy will not increase the survival rate of stage Ⅰ endometrial carcinoma significantly The purpose of such operation is to find out the exact stage and the possible prognosis Distant metastasis is remarkable, and should be considered in the adjuvant therapy