子宫内膜癌合并输卵管癌4例报道及文献复习

Synchronous primary endometrial and fallopian tube cancers: a report of four cases and literature review

目的 ：探讨子宫内膜癌合并输卵管癌患者的临床特征、诊断、治疗和预后。方法 ：对本院于2008年10月—2013年10月收治的4例子宫内膜癌合并输卵管癌患者的病历资料进行复习,并随访至2014年6月30日。结果 ：4例子宫内膜癌合并输卵管癌患者术前诊断均为子宫内膜癌,接受了双侧附件切除＋盆腔淋巴结清扫＋腹主动脉旁淋巴结活检,其中2例行广泛性子宫切除,另2例行筋膜外全子宫切除。术后诊断为ⅠA期子宫内膜样腺癌合并ⅠA/ⅠB期输卵管腺癌。3例患者于术后均接受多西他赛联合铂类方案化疗1-3个周期,1例患者未接受化疗。随访38-71个月,4例患者均为无瘤生存。结论 ：Ⅰ期子宫内膜癌合并Ⅰ期输卵管癌患者的预后较好,治疗可采用子宫及双侧附件切除＋盆腔淋巴结清扫＋腹主动脉旁淋巴结活检的手术方式,而术后化疗的必要性尚有待商榷。

Objective： To evaluate the diagnosis, treatment and prognosis of patients with synchronous primary endometrial and fallopian tube cancers. Methods： The clinical records of four cases of synchronous primary endometrial and fallopian tube cancers from Jiangxi Maternal and Child Health Hospital between October 2008 and October 2013 were reviewed. The follow-up was performed in all patients. The date of last contact was June 30, 2014. Results： The preoperative diagnosis for four cases was endometrial cancer. Two of them underwent extensive abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy, and the other two cases underwent extrafascial abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy. The postoperative diagnosis for four cases was stage ⅠA endometrioid adenocarcinoma and stage ⅠA/ⅠB fallopian tube adenocarcinoma. Three patients received 1-3 cycles of chemotherapy of docetaxel plus platinum, and one patient didn’t receive any chemotherapy. The follow-up time was 38-71 months. All patinets remained tumor-free survival by June 30, 2014. Conclusion： The patients with synchronous primary stage Ⅰ endometrial cancer and stage Ⅰ fallopian tube cancer has a good prognosis, and the extensive/extrafascial abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymph node biopsy are appropriate surgical procedures for these patients. The necessity of postoperative chemotherapy should be further explored.