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目的总结分析不同手术方式对Ⅰ期子宫内膜癌患者的预后,以选择最佳的外科治疗方式。方法回顾性分析上海交通大学医学院附属瑞金医院1995年1月至2008年3月收治的子宫内膜癌患者98例,术前诊断为Ⅰ期。根据手术方式分为两组,A组68例行全子宫双附件切除,B组30例行全子宫双附件切除+盆腔腹主动脉旁淋巴结清扫术,术后随访96~254个月。结果 98例随访率100%。93例最终分期为Ⅰ期的内膜癌病例中,A组5年无瘤生存率88.2%,B组84.0%;术后复发10例(10.8%),其中A组7例,B组3例,两组比较差异无统计学意义(P>0.05)。复发者为ⅠA(<1/2肌层)G2(肿瘤>2 cm)、ⅠB G2、ⅠB G3,及非子宫内膜样腺癌。淋巴结清扫组5例分期上升为ⅢC期,预后不佳。结论对于早期子宫内膜腺癌(ⅠA期),肿瘤细胞分化良好(G1~G2),且无相关高危因素的患者,单纯行全子宫双附件切除术是最佳治疗方案。
Objective To summarize and analyze the prognosis of patients with stage Ⅰ endometrial cancer by different surgical methods in order to choose the best surgical treatment. Methods A retrospective analysis of 98 patients with endometrial cancer admitted to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1995 to March 2008 was performed. According to the surgical approach, the patients were divided into two groups. A group of 68 cases were treated with double hysterectomy, and 30 cases of group B were treated with double hysterectomy plus pelvic abdominal aortic lymph node dissection. The patients were followed up for 96 to 254 months. Results The follow-up rate of 98 cases was 100%. The 93 cases of endometrial cancer with the final stage of stage Ⅰ had a 5-year disease-free survival rate of 88.2% in group A and 84.0% in group B, and 10 cases (10.8%) in group A, with 7 cases in group A and 3 cases in group B , No significant difference between the two groups (P> 0.05). The relapsers were IA (<1/2 muscular layer) G2 (tumor> 2 cm), IB G2, IB G3, and non-endometrioid adenocarcinoma. Lymphadenectomy in 5 cases staged up to Ⅲ C stage, the prognosis is poor. Conclusions For patients with early endometrial adenocarcinoma (stage IA), well-differentiated tumor cells (G1-G2) and no associated risk factors, simple hysterectomy with dual-attachment resection is the best treatment option.