腹主动脉旁淋巴结清扫在早期子宫内膜腺癌治疗中的价值及安全性分析

Value and safety of abdominal paraaortic lymph node dissection in the treatment of early-stage endometrial carcinoma

目的系统的盆腔＋腹主动脉旁淋巴结清扫在子宫内膜腺癌，特别是早期子宫内膜腺癌中尚存在较大争议。文中旨在探讨腹主动脉旁淋巴结清扫在早期子宫内膜腺癌治疗中的价值及手术的安全性。方法回顾性分析2010年1月至2012年12月新疆医科大学附属肿瘤医院收治的109例早期子宫内膜腺癌初治患者的临床资料，将患者按淋巴结清扫范围不同分成2组，盆腔淋巴结清扫组56例，盆腔＋腹主动脉旁淋巴结清扫组53例，比较2组患者术后复发转移情况、并发症及预后相关因素。结果109例患者中12例出现复发转移，盆腔淋巴结清扫组复发转移率明显高于盆腔＋腹主动脉旁淋巴结清扫组（17．86％椰3．77％，P=0．019）。多因素logistics回归分析显示分化程度（OR=7．385，95％CI：1．877—29．062）、病理分期（OR=5．444，95％CI：1．673—17．720）、清扫范围（OR=19．171，95％CI：2．242—163．946）、病灶范围（OR=12．524，95％CI：1．186—132．280）均为影响子宫内膜腺癌患者复发转移的独立因素，其中淋巴结清扫范围对预后影响最大。盆腔淋巴结清扫组、盆腔＋腹主动脉旁淋巴结清扫组患者并发症的发生率分别为19．64％、26．41％，差异无统计学意义（P〉0．05）。结论系统性盆腔＋腹主动脉旁淋巴结清扫术可降低早期子宫内膜腺癌患者复发转移率，改善患者预后，且该手术安全可行。

Objective Systematic pelvic lymph node （SPLN） ＋ abdominal paraaortic lymph node （APLN） dissection remains controversial in the treatment of endometrial carcinoma, especially in the early stage of the tumor. This study aims to investigate the value and safety of APLN dissection in the treatment of early-stage endometrial carcinoma. Methods We retrospectively analyzed the clinical data about 109 cases of early-stage endometrial adenocarcinoma, 56 treated by SPLN dissection （group A） and the other 53 by SPLN ＋ APLN dissection （ group B）. We compared the postoperative complications, recurrence and metastasis, and progno- sis-related factors between the two groups of patients. Results No statistically significant difference was found in the incidence rate of postoperative complications between groups A and B （19.64% vs 26.41%, P 〉 0.05）. Recurrence and metastasis were found in 12 of the 109 patients, 10 in group A and 2 in group B （17.86% vs 3.77% , P = 0. 019）. Multivariate logistic regression analysis showed that the independent factors of recurrence and metastasis includ- ed the differentiation degree （ OR = 7. 385, 95% CI ： 1. 877 - 29. 062）, pathologic stage （ OR -- 5. 444, 95% CI ： 1. 673 - 17. 720）, range of lymph mode dissection （OR = 19. 171, 95% CI：2. 242 - 163. 946） , and range of lesion focus （ OR = 12. 524, 95% CI： 1. 186 - 132. 280）, with the range of lymph mode dissection as the greatest influencing factor on prognosis. Conclusion SPLN ＋ APLN dissection can reduce the recurrence and metastasis and improve the prognosis of early-stage endometrial adenocarcinoma, and therefore is safe and feasible for the treatment of the tumor.