發(fā)布時間：2018-09-07 21:45

【摘要】：目的:子宮內(nèi)膜癌作為常見的女性生殖道惡性腫瘤,近十幾年來其發(fā)病率和死亡率均不斷上升。在大量循證醫(yī)學(xué)證據(jù)基礎(chǔ)上,2009年FIGO重新定義了子宮內(nèi)膜癌的手術(shù)病理分期。由于ⅠA期子宮內(nèi)膜癌的定義發(fā)生了改變,相應(yīng)術(shù)式的選擇也隨之發(fā)生改變。本研究依據(jù)2009年FIGO分期,分析吉林大學(xué)第二醫(yī)院婦科收治的ⅠA期子宮內(nèi)膜癌患者所行術(shù)式及預(yù)后,旨在為ⅠA期子宮內(nèi)膜癌患者的術(shù)式選擇提供參考。方法:收集1995.01.01-2015.12.31吉林大學(xué)第二醫(yī)院婦科收治的經(jīng)術(shù)后病理確診的低危型[1](腫瘤浸潤深度1/2肌層、G1或者G2)早期子宮內(nèi)膜樣腺癌患者758例,其中1995-2009年確診的ⅠA期、ⅠB期病例按2009年分期合并為ⅠA期,2009年之后病例分期不變。對納入的所有ⅠA期病例所行術(shù)式及預(yù)后進(jìn)行回顧性分析,應(yīng)用excel軟件建立數(shù)據(jù)庫,IBM SPSS Statistics 21.0進(jìn)行統(tǒng)計分析�？ǚ綑z驗(yàn)/Fisher精確檢驗(yàn)作為計數(shù)資料及其組間比較的統(tǒng)計學(xué)方法,計量資料及其組間比較分別應(yīng)用方差分析和t檢驗(yàn)/LSD法,統(tǒng)計檢驗(yàn)均為雙側(cè),P0.05認(rèn)為差異具有統(tǒng)計學(xué)意義。結(jié)果:1.共納入758例低危型ⅠA期子宮內(nèi)膜樣腺癌患者。其中僅行全子宮切除術(shù)者33例(4.35%);行全子宮+雙側(cè)附件切除術(shù)者218例(28.76%);行全子宮+雙側(cè)附件+盆腔淋巴結(jié)±腹主動脈旁淋巴結(jié)切除術(shù)者507例(66.89%)。2.ⅠA期中腫瘤局限于子宮內(nèi)膜者155例(20.45%)。其中僅行全子宮切除術(shù)者16例(10.32%);行全子宮+雙側(cè)附件切除術(shù)者58例(37.42%);行全子宮+雙側(cè)附件+盆腔淋巴結(jié)±腹主動脈旁淋巴結(jié)切除術(shù)者81例(52.26%)。3.ⅠA期中腫瘤浸潤深度1/2肌層者603例(79.55%)。其中僅行全子宮切除術(shù)者17例(2.82%);行全子宮+雙側(cè)附件切除術(shù)者160例(26.53%);行全子宮+雙側(cè)附件+盆腔淋巴結(jié)±腹主動脈旁淋巴結(jié)切除術(shù)者426例(70.65%)。4.ⅠA期中腫瘤局限于子宮內(nèi)膜者,行淋巴結(jié)切除術(shù)與不行淋巴結(jié)切除術(shù)相比,在手術(shù)時間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后并發(fā)癥、術(shù)后排氣時間、術(shù)后留置尿管時間、術(shù)后住院天數(shù)上差異有統(tǒng)計學(xué)意義;在復(fù)發(fā)/轉(zhuǎn)移率、5年生存率、無瘤生存期上差異無統(tǒng)計學(xué)意義。5.ⅠA期中腫瘤浸潤深度1/2肌層者,行淋巴結(jié)切除術(shù)與不行淋巴結(jié)切除術(shù)相比,在手術(shù)時間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后并發(fā)癥、術(shù)后排氣時間、術(shù)后留置尿管時間、術(shù)后住院天數(shù)上差異有統(tǒng)計學(xué)意義;在復(fù)發(fā)/轉(zhuǎn)移率、5年生存率、無瘤生存期上差異無統(tǒng)計學(xué)意義。6.40歲以下低危型ⅠA期中腫瘤局限子宮內(nèi)膜者,行全子宮+雙側(cè)附件切除術(shù)與僅行全子宮切除術(shù)相比,在復(fù)發(fā)/轉(zhuǎn)移率、無瘤生存期上差異無統(tǒng)計學(xué)意義;但在5年生存率上,行全子宮+雙側(cè)附件切除術(shù)者低于僅行全子宮切除術(shù)者,差異有統(tǒng)計學(xué)意義。7.40歲以下低危型ⅠA期中腫瘤浸潤深度1/2肌層者,行全子宮+雙側(cè)附件切除術(shù)與僅行全子宮切除術(shù)相比,在復(fù)發(fā)/轉(zhuǎn)移率、無瘤生存期上差異無統(tǒng)計學(xué)意義;但在5年生存率上,行全子宮+雙側(cè)附件切除術(shù)者低于僅行全子宮切除術(shù)者,差異有統(tǒng)計學(xué)意義。結(jié)論:1.對于低危型ⅠA期子宮內(nèi)膜樣腺癌患者,無論腫瘤是局限于子宮內(nèi)膜還是浸潤深度1/2肌層,淋巴結(jié)切除與否并不影響患者預(yù)后。行淋巴結(jié)切除不僅不能改善預(yù)后,還增加了手術(shù)時間、術(shù)中出血量、術(shù)中、術(shù)后并發(fā)癥發(fā)生率,延緩了患者的術(shù)后恢復(fù)時間。2.對于年齡40歲低危型ⅠA期子宮內(nèi)膜癌患者,無論腫瘤是局限于子宮內(nèi)膜還是浸潤深度1/2肌層,切除卵巢與否并不影響疾病復(fù)發(fā)/轉(zhuǎn)移率和無瘤生存期,保留卵巢的術(shù)式是可行的,但仍需要更多的研究加以證實(shí)。
[Abstract]:Objective: Endometrial carcinoma, as a common malignant tumor of female genital tract, has been increasing in morbidity and mortality in recent ten years. Based on a large amount of evidence-based medical evidence, FIGO redefined the surgical pathological stage of endometrial carcinoma in 2009. According to the FIGO staging in 2009, this study analyzed the surgical procedures and prognosis of stage I A endometrial carcinoma patients in the Second Hospital of Jilin University. The purpose was to provide reference for the surgical selection of stage I A endometrial carcinoma patients. 758 patients with early stage endometrioid adenocarcinoma of low-risk type [1] (tumor invasion depth 1/2 myometrium, G1 or G2), of whom stage I A and stage I B were diagnosed from 1995 to 2009, were combined into stage I A according to the stage of 2009, and the stage of cases remained unchanged after 2009. Chi-square test/Fisher exact test was used as the statistical method for counting data and comparing between groups. Variance analysis and t-test/LSD were used for measuring data and comparing between groups. Statistical tests were bilateral, P 0.05 showed significant difference. A total of 758 patients with low-risk stage I A endometrioid adenocarcinoma were enrolled, of which 33 (4.35%) underwent total hysterectomy alone, 218 (28.76%) underwent total hysterectomy plus bilateral appendectomy, and 507 (66.89%) underwent total hysterectomy plus bilateral appendix + pelvic lymph node + para-aortic lymphadenectomy. Total hysterectomy was performed in 16 cases (10.32%), total hysterectomy plus bilateral adnexal resection in 58 cases (37.42%) and total hysterectomy plus bilateral adnexal resection in 81 cases (52.26%). Total hysterectomy plus bilateral adnexal resection was performed in 160 cases (26.53%) and total hysterectomy plus bilateral adnexal resection plus pelvic lymph node + para-aortic lymphadenectomy in 426 cases (70.65%). Postoperative complications, postoperative exhaust time, postoperative indwelling catheter time, postoperative hospitalization days were significantly different; there was no significant difference in the recurrence / metastasis rate, 5-year survival rate, tumor-free survival time. 5. In stage I A patients with tumor infiltration depth of 1/2 muscular layer, lymphadenectomy compared with no lymphadenectomy, operation time, operation time, operation time. There were significant differences in bleeding volume, intraoperative complications, postoperative complications, postoperative exhaust time, postoperative indwelling catheter time, postoperative hospitalization days; there was no significant difference in recurrence/metastasis rate, 5-year survival rate, and tumor-free survival rate. There was no significant difference in recurrence/metastasis rate and tumor-free survival between hysterectomy and hysterectomy alone, but in 5-year survival rate, the total hysterectomy plus bilateral adnexal resection was lower than the total hysterectomy alone. The difference was statistically significant. 7. There was no significant difference in recurrence/metastasis rate and tumor-free survival between hysterectomy plus bilateral adnexal excision and hysterectomy alone, but the 5-year survival rate of patients who underwent hysterectomy plus bilateral adnexal excision was lower than that of patients who underwent hysterectomy alone. Lymphadenectomy can not only improve the prognosis, but also increase the operation time, intraoperative bleeding, intraoperative and postoperative complications, and delay the recovery time of patients. 2. For low-risk patients aged 40 years, stage I A. In patients with endometrial carcinoma, whether the tumor is confined to the endometrium or invasive depth of 1/2 myometrium, ovariectomy does not affect the recurrence/metastasis rate and tumor-free survival. Ovarian-sparing surgery is feasible, but more studies are needed to confirm it.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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