重视早期子宫内膜癌与腹腔镜手术相关不良预后因素

腹腔镜手术已成为早期子宫内膜癌常规治疗手段之一。为降低腹腔冲洗液肿瘤细胞阳性率，要避免使用球囊式举宫器，严格操作流程，提高腹腔冲洗液肿瘤细胞诊断的准确性。单纯肿瘤细胞阳性不影响预后，不合并其他高危因素时不建议术后辅助治疗，但需全面进行手术病理分期并报告腹腔冲洗液肿瘤细胞结果，阳性者应严密监测随访。目前尚缺乏确切资料证明腹腔镜手术会增加阴道残端肿瘤复发率，但术前应全面评估子宫大小、临床分期等，避免术中宫内容溢出，降低术后阴道断端复发的风险。早期子宫内膜癌的穿刺口肿瘤种植发生率低于其他妇科恶性肿瘤，术者侧发生率高，组织类型差、病理级别高、术中子宫穿孔等为穿刺口种植的高危因素。遵循无瘤操作原则可减少腹腔镜术后腹部穿刺孔肿瘤种植或转移（ port site metastases，PSM）的发生。

Pay attention to early endometrial cancer and adverse prognostic factors associated with laparoscopic surgery

Laparoscopic surgery has become one of the treatment methods for early endometrial cancer. In order to reduce the positive rate of tumor cells in peritoneal lavage fluid, the operator should avoid the use of balloon type uterine manipulator, strict operating procedures, and improve the accuracy of diagnosis of tumor cells in peritoneal lavage fluid. Tumor cell positivity alone had no prognostic effect and adjuvant therapy should not be performed without other risk factors. But it is needed to be associated with comprehensive pathological report and peritoneal lavage fluid result. If a positive result with tumor cells is obtained, close monitoring of follow-up is required. It is lack of exact data showing that laparoscopic surgery can increase the vaginal stump recurrence rate. But a comprehensive assessment of the size of the uterus before surgery and clinical staging need to be performed. Uterine content overflow should be avoided during surgery to reduce the risk of vaginal stump recurrence. Tumor implantation at the puncture site for early endometrial cancer has lower incidence than other gynecologic malignant tumors, occurs more frequently at the operator site and are pathologically poorly differentiated and high grade. Uterine perforation during operation is a risk factor for tumor implantation at the puncture site. Obey of non-tumor operation principle can reduce the occurrence of tumor implantation or port site metastases.