不同手术方式对Ⅰ期子宫内膜样腺癌患者生存及复发的影响

发布时间：2018-03-07 18:12

本文选题：Ⅰ期子宫内膜样腺癌　切入点：盆腔淋巴结清扫术　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:近年来子宫内膜癌的发病率呈逐渐上升趋势,且高收入国家的发病率高于低收入国家。由于子宫内膜癌患者早期常有异常阴道出血的症状,能够及时就诊,多数患者(75%)确诊时属于Ⅰ期,因此子宫内膜癌的预后普遍较好。目前子宫内膜癌的治疗仍是以手术治疗为主,以放化疗和激素治疗为辅的综合治疗。2015年FIGO指南指出I期子宫内膜癌的基本术式是筋膜外全子宫加双侧附件切除术,然而2016年NCCN指南推荐若无手术禁忌和技术限制,最好还是行全面分期手术(盆腹腔冲洗液留取脱落细胞+全子宫双附件切除术+盆腔及腹主动脉旁淋巴结清扫术)。目前对于Ⅰ期子宫内膜样腺癌患者行盆腔及腹主动脉旁淋巴结切除的治疗价值仍存在很大争议。本研究拟通过比较不同手术方式对I期子宫内膜样腺癌患者生存及复发的影响,以期为Ⅰ期子宫内膜样腺癌的处理提供参考依据。方法:回顾性分析2005年1月-2014年12月期间于河北医科大学第二医院行手术治疗的Ⅰ期子宫内膜样腺癌患者199例。根据手术方式不同分为两组:A组行全子宫+双侧附件切除术,共88例,B组行全子宫+双侧附件切除术+盆腔淋巴结清扫术,共111例。对两组的术后并发症发生率、复发率及生存率进行比较。结果:A、B两组之间术后并发症的发生率相比具有统计学意义(P=0.020.05),两组之间复发率相比无统计学差异(P=0.400.05),1年、3年、5年生存率相比亦无统计学差异(P分别为0.259、0.427、0.713,,均0.05)。结论:对于I期子宫内膜样腺癌患者行盆腔淋巴结清扫术有助于明确手术病理分期,但并不能提高患者的生存率和降低复发率,反而会增加术后并发症的发生率。
[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.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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