本文選題：Ⅰ期子宮內(nèi)膜樣腺癌　切入點(diǎn)：盆腔淋巴結(jié)清掃術(shù)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:近年來(lái)子宮內(nèi)膜癌的發(fā)病率呈逐漸上升趨勢(shì),且高收入國(guó)家的發(fā)病率高于低收入國(guó)家。由于子宮內(nèi)膜癌患者早期常有異常陰道出血的癥狀,能夠及時(shí)就診,多數(shù)患者(75%)確診時(shí)屬于Ⅰ期,因此子宮內(nèi)膜癌的預(yù)后普遍較好。目前子宮內(nèi)膜癌的治療仍是以手術(shù)治療為主,以放化療和激素治療為輔的綜合治療。2015年FIGO指南指出I期子宮內(nèi)膜癌的基本術(shù)式是筋膜外全子宮加雙側(cè)附件切除術(shù),然而2016年NCCN指南推薦若無(wú)手術(shù)禁忌和技術(shù)限制,最好還是行全面分期手術(shù)(盆腹腔沖洗液留取脫落細(xì)胞+全子宮雙附件切除術(shù)+盆腔及腹主動(dòng)脈旁淋巴結(jié)清掃術(shù))。目前對(duì)于Ⅰ期子宮內(nèi)膜樣腺癌患者行盆腔及腹主動(dòng)脈旁淋巴結(jié)切除的治療價(jià)值仍存在很大爭(zhēng)議。本研究擬通過比較不同手術(shù)方式對(duì)I期子宮內(nèi)膜樣腺癌患者生存及復(fù)發(fā)的影響,以期為Ⅰ期子宮內(nèi)膜樣腺癌的處理提供參考依據(jù)。方法:回顧性分析2005年1月-2014年12月期間于河北醫(yī)科大學(xué)第二醫(yī)院行手術(shù)治療的Ⅰ期子宮內(nèi)膜樣腺癌患者199例。根據(jù)手術(shù)方式不同分為兩組:A組行全子宮+雙側(cè)附件切除術(shù),共88例,B組行全子宮+雙側(cè)附件切除術(shù)+盆腔淋巴結(jié)清掃術(shù),共111例。對(duì)兩組的術(shù)后并發(fā)癥發(fā)生率、復(fù)發(fā)率及生存率進(jìn)行比較。結(jié)果:A、B兩組之間術(shù)后并發(fā)癥的發(fā)生率相比具有統(tǒng)計(jì)學(xué)意義(P=0.020.05),兩組之間復(fù)發(fā)率相比無(wú)統(tǒng)計(jì)學(xué)差異(P=0.400.05),1年、3年、5年生存率相比亦無(wú)統(tǒng)計(jì)學(xué)差異(P分別為0.259、0.427、0.713,,均0.05)。結(jié)論:對(duì)于I期子宮內(nèi)膜樣腺癌患者行盆腔淋巴結(jié)清掃術(shù)有助于明確手術(shù)病理分期,但并不能提高患者的生存率和降低復(fù)發(fā)率,反而會(huì)增加術(shù)后并發(fā)癥的發(fā)生率。
[Abstract]:Objective: in recent years, the incidence of endometrial cancer is increasing, and the incidence rate is higher than the high income countries in low income countries. Due to the early endometrial cancer patients often have abnormal vaginal bleeding symptoms, to timely treatment, most patients (75%) belong to the stage at diagnosis, so the prognosis of endometrial cancer is generally better at present the treatment of endometrial carcinoma is mainly treated by operation, the comprehensive treatment of.2015 chemotherapy and hormone therapy supplemented by the FIGO guidelines pointed out that basic surgery for stage I endometrial cancer is extrafascial hysterectomy and bilateral adnexectomy, while the 2016 NCCN guidelines recommend if no contraindications and technical limitations, or for the best comprehensive staging surgery (pelvic peritoneal lavage fluid collected exfoliated cells + hysterectomy + pelvic and paraaortic lymphadenectomy). For patients with stage I endometrial adenocarcinoma Therapeutic value of pelvic and paraaortic lymph node dissection is still controversial. This study by comparing the different surgical methods influence on stage I endometrioid adenocarcinoma patients survival and recurrence, to provide reference for the treatment of stage I endometrial adenocarcinoma. Methods: a retrospective analysis of January 2005 -2014 in December, during the stage I endometrial adenocarcinoma patients in the second hospital of Hebei Medical University underwent surgery in 199 cases. According to the operation were divided into two groups: group A underwent hysterectomy and bilateral adnexectomy, a total of 88 cases, group B underwent hysterectomy plus bilateral accessory resection and pelvic lymph node dissection, a total of 111 The incidence of two cases. Postoperative complications, recurrence rate and survival rate were compared. Results: A, B rate compared with statistical significance between the two groups of postoperative complications between the two groups (P=0.020.05), the recurrence rate compared with no statistical differences ( P=0.400.05), 1 years, 3 years, 5 years survival rate also compared no significant difference (P = 0.259,0.427,0.713, 0.05). Conclusion: for patients with stage I endometrial adenocarcinoma pelvic lymph node dissection can help clear the surgical pathological staging, but did not improve survival and reduce the recurrence rate, but will increase the incidence of postoperative complications.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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