系统淋巴结切除在子宫内膜癌治疗中的临床意义探讨

The Clinical Significance of Systematic Lymphadenectomy in Treatment of Endometrial Cancer

目的:探讨子宫内膜癌患者在行系统(盆腔加腹主动脉旁)淋巴结切除的临床意义,以提高子宫内膜癌的疗效。方法:收集我院在2007年4月至2012年3月行系统淋巴结切除,并经病理检查确诊为子宫内膜癌的患者91例,分析其术中术后情况、腹主动脉旁淋巴结转移的影响因素及与生存率的关系。结果:91例患者中29例出现淋巴结转移,转移率为31.9%,其中盆腔淋巴结转移20例(22.0%),腹主动脉旁淋巴结转移23例(25.3%)。发生术中并发症6例(6.6%),术后并发症8例(8.8%)。多因素分析显示,非子宫内膜样癌、低分化(G3)、子宫肌层浸润深度>1/2、盆腔淋巴结转移是腹主动脉旁淋巴结转移的独立危险因素。腹主动脉旁淋巴结转移患者的累积生存率(36.9%)明显低于无淋巴结转移患者累积生存率(91.9%),差异有统计学意义(P<0.05)。结论:系统淋巴结切除对提高子宫内膜癌的疗效非常重要,且安全可行。

Objective： To investigate the clinical significance of systematic lymphadenectomy（ pelvic and/ or para-aortic） in treatment of endometrial cancer. Methods ：91 patients with endometrial cancer in Affiliated Tumor Hospital of Guangxi Medical University from April 2007 to March 2012 were enrolled in this study. The intraoperative and postoperative conditions, the risk factors of para-aortic lymph node metastasis, and survival rate were analyzed. Results：Twenty-nine（31.9%）of 91 patients had lymph node metastasis, including 20 with pelvic lymph node metastasis （22.0%） and 23 with para-aortic lymph node metastasis （25. 3% ）. The multivariate analysis showed that non-endometrioid adenocarcinoma,G3,myometrial invasion,and pelvic lymph node metastasis were independent risk factors for para-aortic lymph node metastasis. The cumulative survival rate for patients with para-aortic lymph node metastasis was 36. 9% ,which was significantly lower than those without lymph node me- tastasis（91.9%, P 〈0. 05）. Conclusions：It is beneficial and feasible to do systematic lymphadenectomy in patients with endometrial cancer.