本文選題：子宮內(nèi)膜樣腺癌 + 改良根治性子宮切除術(shù)　； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：目的：探討改良根治子宮切除術(shù)在Ⅰ期中危子宮內(nèi)膜樣腺癌患者中的治療價值。主要結(jié)局為局部復(fù)發(fā)率,次要結(jié)局為專病死亡率、手術(shù)相關(guān)并發(fā)癥發(fā)生率。評估改良根治子宮切除術(shù)是否可以在不降低局部控制率和生存獲益的前提下,減少Ⅰ期子宮內(nèi)膜樣腺癌患者的治療相關(guān)并發(fā)癥,代替輔助放療作為患者的另一治療選擇。材料與方法：回顧性分析復(fù)旦大學(xué)腫瘤醫(yī)院2004年1月至2008年12月期間收治的初治行改良根治子宮切除術(shù)的子宮內(nèi)膜樣腺癌患者的臨床病理資料,根據(jù)復(fù)旦大學(xué)腫瘤醫(yī)院婦科腫瘤診療指南標準篩選出中危亞組患者,應(yīng)用Kaplan-Meier法對中危組患者的復(fù)發(fā)、生存情況進行分析；應(yīng)用cox回歸法對影響預(yù)后的因素進行分析；統(tǒng)計手術(shù)時間、出血量、輸血比率、輸血量、手術(shù)相關(guān)并發(fā)癥。結(jié)果：共有328例Ⅰ期(Federation International of Gynecology and Obstetrics 2009, FIGO 2009)子宮內(nèi)膜樣腺癌患者在我院初治行改良根治性子宮切除+雙附件切除±盆腔淋巴結(jié)清掃±腹主動脈旁淋巴結(jié)清掃+腹腔沖洗液細胞學(xué)檢查。其中中危組患者共168例,高中危組(high-intermediate risk, HIR)38例,低中危(low- intermediate risk, LIR)組130例。中位隨訪時間69.5個月(50.8-85.25月)；9例患者術(shù)后復(fù)發(fā)：3例局部復(fù)發(fā)(陰道復(fù)發(fā)或盆腔復(fù)發(fā)),6例遠處轉(zhuǎn)移；3例死于子宮內(nèi)膜癌。所有復(fù)發(fā)患者的中位無進展生存期為40個月(17-46月),中位生存時間為65個月(27-78.5月)；中�；颊咧杏�27%行輔助治療,總體的3年和5年的累積孤立局部復(fù)發(fā)率皆為1.4%,腫瘤專病生存率為98.6%和97.8%。高中危組和低中危組3年和5年累積總局部復(fù)發(fā)率分別為0%和0%vsl.7%和1.7%(x2=0.825,P=0.346)；專病生存率為100%和93.3%vs98.2%和98.2%(x 2=0.242,P=0.623)。中危組未行輔助治療的患者,3年、5年生存率分別為99.0%和98.0%；3年、5年累積局部復(fù)發(fā)率分別為1%。高中危組中未行輔助治療組3年、5年專病生存率分別為100%和90%,累積局部復(fù)發(fā)率分別為0；低中危組未行輔助治療的患者3年、5年專病生存率分別為98.9%；累積局部復(fù)發(fā)率分別為1.1%。168例中�；颊咧�,中位手術(shù)時間為130min(107-150min),中位出血量為300ml (200-400ml)。21例患者術(shù)中或術(shù)后接受輸血,輸血比率為12.5%(21/168)。手術(shù)相關(guān)并發(fā)癥發(fā)生率4.8%,其中泌尿生殖系統(tǒng)并發(fā)癥發(fā)生率為1.8%。結(jié)論：本研究中行改良根治子宮切除術(shù)的中危組患者,輔助治療施行率低,而局部控制效果、生存獲益較好,手術(shù)相關(guān)并發(fā)癥發(fā)生率低。
[Abstract]:Objective: to evaluate the value of modified radical hysterectomy in the treatment of stage I endometrial adenocarcinoma. The main outcome was local recurrence rate, the secondary outcome was specific mortality, and the incidence of operation-related complications. To evaluate whether modified radical hysterectomy can reduce treatment-related complications in patients with stage I endometrial adenocarcinoma without reducing the local control rate and survival benefit, instead of adjuvant radiotherapy as another treatment option. Materials and methods: the clinical and pathological data of patients with endometrial adenocarcinoma treated by modified radical hysterectomy in Fudan University Cancer Hospital from January 2004 to December 2008 were analyzed retrospectively. According to the criteria for diagnosis and treatment of gynecological tumors in Fudan University Cancer Hospital, the patients in the middle risk subgroup were screened out, the recurrence and survival of the patients in the middle risk group were analyzed by Kaplan-Meier method, the factors influencing the prognosis were analyzed by cox regression method. Operation time, blood loss, blood transfusion ratio, blood transfusion volume, and complications associated with surgery were counted. Results: a total of 328 patients with stage 鈪，

本文編號：1979365