早期子宫内膜癌不同术式及预后的比较
发布时间：2018-09-07 21:45
【摘要】：目的:子宫内膜癌作为常见的女性生殖道恶性肿瘤,近十几年来其发病率和死亡率均不断上升。在大量循证医学证据基础上,2009年FIGO重新定义了子宫内膜癌的手术病理分期。由于ⅠA期子宫内膜癌的定义发生了改变,相应术式的选择也随之发生改变。本研究依据2009年FIGO分期,分析吉林大学第二医院妇科收治的ⅠA期子宫内膜癌患者所行术式及预后,旨在为ⅠA期子宫内膜癌患者的术式选择提供参考。方法:收集1995.01.01-2015.12.31吉林大学第二医院妇科收治的经术后病理确诊的低危型[1](肿瘤浸润深度1/2肌层、G1或者G2)早期子宫内膜样腺癌患者758例,其中1995-2009年确诊的ⅠA期、ⅠB期病例按2009年分期合并为ⅠA期,2009年之后病例分期不变。对纳入的所有ⅠA期病例所行术式及预后进行回顾性分析,应用excel软件建立数据库,IBM SPSS Statistics 21.0进行统计分析。卡方检验/Fisher精确检验作为计数资料及其组间比较的统计学方法,计量资料及其组间比较分别应用方差分析和t检验/LSD法,统计检验均为双侧,P0.05认为差异具有统计学意义。结果:1.共纳入758例低危型ⅠA期子宫内膜样腺癌患者。其中仅行全子宫切除术者33例(4.35%);行全子宫+双侧附件切除术者218例(28.76%);行全子宫+双侧附件+盆腔淋巴结±腹主动脉旁淋巴结切除术者507例(66.89%)。2.ⅠA期中肿瘤局限于子宫内膜者155例(20.45%)。其中仅行全子宫切除术者16例(10.32%);行全子宫+双侧附件切除术者58例(37.42%);行全子宫+双侧附件+盆腔淋巴结±腹主动脉旁淋巴结切除术者81例(52.26%)。3.ⅠA期中肿瘤浸润深度1/2肌层者603例(79.55%)。其中仅行全子宫切除术者17例(2.82%);行全子宫+双侧附件切除术者160例(26.53%);行全子宫+双侧附件+盆腔淋巴结±腹主动脉旁淋巴结切除术者426例(70.65%)。4.ⅠA期中肿瘤局限于子宫内膜者,行淋巴结切除术与不行淋巴结切除术相比,在手术时间、术中出血量、术中并发症、术后并发症、术后排气时间、术后留置尿管时间、术后住院天数上差异有统计学意义;在复发/转移率、5年生存率、无瘤生存期上差异无统计学意义。5.ⅠA期中肿瘤浸润深度1/2肌层者,行淋巴结切除术与不行淋巴结切除术相比,在手术时间、术中出血量、术中并发症、术后并发症、术后排气时间、术后留置尿管时间、术后住院天数上差异有统计学意义;在复发/转移率、5年生存率、无瘤生存期上差异无统计学意义。6.40岁以下低危型ⅠA期中肿瘤局限子宫内膜者,行全子宫+双侧附件切除术与仅行全子宫切除术相比,在复发/转移率、无瘤生存期上差异无统计学意义;但在5年生存率上,行全子宫+双侧附件切除术者低于仅行全子宫切除术者,差异有统计学意义。7.40岁以下低危型ⅠA期中肿瘤浸润深度1/2肌层者,行全子宫+双侧附件切除术与仅行全子宫切除术相比,在复发/转移率、无瘤生存期上差异无统计学意义;但在5年生存率上,行全子宫+双侧附件切除术者低于仅行全子宫切除术者,差异有统计学意义。结论:1.对于低危型ⅠA期子宫内膜样腺癌患者,无论肿瘤是局限于子宫内膜还是浸润深度1/2肌层,淋巴结切除与否并不影响患者预后。行淋巴结切除不仅不能改善预后,还增加了手术时间、术中出血量、术中、术后并发症发生率,延缓了患者的术后恢复时间。2.对于年龄40岁低危型ⅠA期子宫内膜癌患者,无论肿瘤是局限于子宫内膜还是浸润深度1/2肌层,切除卵巢与否并不影响疾病复发/转移率和无瘤生存期,保留卵巢的术式是可行的,但仍需要更多的研究加以证实。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
本文编号：2229508
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
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