不同手术方式对Ⅰ期子宫内膜癌患者生存及复发的影响

目的 了解不同手术方式对Ⅰ期子宫内膜癌患者术后生存及复发的影响.方法 回顾性分析1986～1996年行手术治疗的Ⅰ期子宫内膜癌患者110例,根据手术方式不同将其分为3组,行全子宫+双侧附件切除术者为A组(54例);行广泛或次广泛性全子宫切除术者为B组(14例);行全子宫+双侧附件切除(或广泛性全子宫切除或次广泛全子宫切除)+盆腔淋巴结清扫术者为C组(42例),分析3组的生存和复发情况.结果 A、B、C 3组的5年生存率分别为89.5%、90.5%、95.1%,3组间比较,差异无显著性(P>0.05).随诊超过2年的71例中9例复发,复发率为12.7%;9例复发者中7例于3年内复发,其中盆腔局部复发8例,远处转移5例;A、B、C 3组的复发率分别为13.9%、9.1%、12.5%,其中盆腔局部复发率分别为13.9%、9.1%、8.3%,远处转移率分别为2.8%、9.1%、12.5%,分别比较,差异均无显著性(P>0.05).结论 手术方式不是影响Ⅰ期子宫内膜癌患者生存率的主要因素,扩大手术范围或行淋巴结清扫术并不能显著提高患者的生存率.远处转移在术后复发患者中占有相当的比例,辅助治疗时应考虑术后复发的这种特点.     

子宫内膜癌术中区域性动脉灌注化疗的疗效观察

目的探讨术中区域性动脉灌注化疗对子宫内膜癌的治疗效果.方法回顾性分析我院2000年1月～2002年11月间在我科施行了术中动脉灌注化疗的20例子宫内膜癌患者(灌注组),选择同期手术治疗的子宫内膜癌患者33例为对照(对照组),分析两组的复发及死亡情况.结果灌注组中Ⅰ期8例,Ⅱ期8例,Ⅲ期4例,Ⅳ 0例,其中1例Ⅲ a G2者于术后8个月盆腔复发,无1例死亡,复发率为5.0%.对照组中Ⅰ期25例,Ⅱ期3例,Ⅲ期4例,Ⅳ1例,其中3例复发,复发率为9.1%.复发者分别为Ⅰ b G2 - 3,Ⅰ c G3和Ⅲ c G3,1例为阴道断端复发,1例为盆腔复发,1例为远处脏器转移,其中2例死亡,死亡率为6.1%.两组的平均随访时间为 15.6±5.2(个月)及16.8±7.4(个月),差异无显著性(P>0.05).结论术中髂内动脉灌注化疗可降低子宫内膜癌的复发率,且操作简单易于掌握,既具有术前选择性动脉灌注化疗的优点又可避免其弊端,值得临床推广.     

不同手术方式对I期子宫内膜癌患者生存及复发的影响

目的：了解不同手术方式对I期子宫内膜癌患者术后生存及复发的影响。方法：回顾性分析1986－1996年行手术治疗的I期子宫内膜癌患者110例,根据手术方式不同将其分为3组,行全子宫＋双侧附件切除术者为A组（54例）;行广泛或次广泛性全子宫切除术者为B组（14例）;行全子宫＋双侧附件切除（或广泛性全子宫切除或次广泛全子宫切除）＋盆腔淋巴结清扫术者为C组（42例）,分析3组的生存和复发情况。结果：A、B、C3组的5年生存率分别为89．5％、90．5％、95．1％,3组间比较,差异无显著性（P＞0．05）。随诊超过2年的71例中9例复发,复发率为12．7％;9例复发者中7例于3年内复发,其中盆腔局部复发8例,远处转移5例;A、B、C3组的复发率分别为13．9％、9．1％、12．5％,其中盆腔局部复发率分别为13．9％、9．1％、8．3％,远处转移率分别为2．8％、9．1％、12．5％,分别比较,差异均无显著性（P＞0．05）。结论：手术方式不是影响I期子宫内膜癌患者生存率的主要因素,扩大手术范围或行淋巴结清扫术并不能显著提高患者的生存率。远处转移在术后复发患者中占有相当的比例,辅助治疗时应考虑术后复发的这种特点。     

不同手术方式对Ⅰ期子宫内膜癌患者的预后分析

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(P0.05)。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。     

Ⅰ期子宫内膜癌盆腔淋巴清扫术的意义

目的:探讨Ⅰ期子宫内膜癌患者预后的相关因素及盆腔淋巴清扫术对其预后可能的影响。方法:收集1997年8月至2005年3月浙江大学医学院附属妇产科医院临床Ⅰ期子宫内膜癌患者202例,分析影响预后的各项临床病理指标,寿命表法计算生存率,比较盆腔淋巴清扫组与平行淋巴结清扫组的复发率,并发症。结果:Ⅰ期子宫内膜癌盆腔淋巴转移率1·53%。病理类型、腹腔细胞学、盆腔淋巴转移、手术-病理分期、肌层浸润及CA125值是影响预后的独立因素。Ⅰ期低危患者,盆腔淋巴清扫术无助于提高生存率(P>0.05),其复发率也无明显差异(P>0.05),手术并发症率明显增高(P<0.05);Ⅰ期高危患者,盆腔淋巴清扫术未能延长其生存期(P>0·05),但可减少复发的例数,并发症率无明显增多(P>0.05)。结论:特殊病理类型,腹腔细胞学阳性,手术-病理分期高,盆腔淋巴转移,深肌层浸润及CA125>100U/ml的患者预后较差(P<0.05)。Ⅰ期高危子宫内膜癌患者盆腔淋巴清扫术具有一定的临床意义。     

宫颈癌根治术中加行腹主动脉旁淋巴结切除在ⅠB2及ⅡA2期宫颈癌治疗中的临床价值

目的:探讨宫颈癌根治术中加行腹主动脉旁淋巴结切除在Ⅰ B2及ⅡA2期宫颈癌治疗中的临床应用价值.方法:选择2006年5月至2011年7月在我院诊治的Ⅰ B2及ⅡA2期宫颈癌患者86例,分成两组.对照组45例,行宫颈癌根治术;观察组41例,宫颈癌根治术中加行腹主动脉旁淋巴结切除术;两组术后辅以放疗或放化疗.对两组术中、术后情况及复发率、生存率进行比较分析,并分析盆腔淋巴结转移、腹主动脉旁淋巴结转移与临床病理因素的关系.结果:观察组复发6例,复发率为15.0％;48个月总生存率和无瘤生存率均为70.0％.对照组复发17例,复发率为38.6％;48个月总生存率和无瘤生存率分别为68.0％和66.0％.两组比较,差异均有统计学意义(P＜0.05).两组并发症发生率(29.3vs 40.0％)、术中出血量(325.0±58.0ml vs 315.0±50.1 ml)及盆腔淋巴结阳性率(56.1％vs 57.8％)比较,差异均无统计学意义(P＞0.05).观察组中腹主动脉旁淋巴结阳性率为17.1％,盆腔淋巴结转移个数与腹主动脉旁淋巴结转移呈正相关(P＜0.01).单因素分析表明腹主动脉旁淋巴结转移是影响宫颈癌患者预后的因素之一(P＜0.05);多因素分析则表明盆腔淋巴结转移个数及腹主动脉旁淋巴结转移是影响宫颈癌患者预后的因素之一(P＜0.05).结论:宫颈癌盆腔淋巴结转移个数与腹主动脉旁淋巴结转移有关.在宫颈癌根治性手术中加腹主动脉旁淋巴结切除并辅以术后治疗,可以降低复发率,提高生存率,且安全可行.     

358例子宫内膜癌手术方式及影响预后的危险因素分析

目的:探讨子宫内膜癌的手术方式及影响预后的危险因素。方法:回顾性分析资料完整、初治为手术治疗并经病理学诊断确诊,且进行系统分期手术的358例子宫内膜癌患者的临床情况及手术方式,并进行随访。对可能影响子宫内膜癌患者预后的危险因素进行分析。结果:358例患者中位发病年龄52岁(20~78岁),3年总体无瘤生存率分别为Ⅰ期97.12%,Ⅱ期91.67%;Ⅲ期85.19%,复发及死亡14例。开腹手术326例(91.06%),腹腔镜手术32例(8.94%)。与开腹组手术患者比较,腹腔镜组手术时间较长、平均估计术中失血量较少且平均住院时间短,差异有统计学意义(P0.05)。单因素分析表明,有内科合并症、手术病理分期晚、仅行盆腔淋巴结取样、脉管癌栓阳性、盆腔和(或)腹主动脉旁淋巴结转移是影响子宫内膜癌患者预后的危险因素;多因素分析表明,盆腔淋巴结转移是影响子宫内膜癌患者预后的独立危险因素(P=0.000,OR=11.901,95%CI3.291~43.039)。结论:子宫内膜癌以开腹手术为主,腹腔镜手术显示了微创的优势。手术病理分期晚期、伴有内科合并症、仅行盆腔淋巴结取样术、脉管癌栓阳性、腹主动脉旁淋巴结转移,特别是有盆腔淋巴结转移的子宫内膜癌患者预后差。     

子宫内膜癌手术方式的选择与预后

目的 探讨各种手术方式对子宫内膜癌患者预后的影响。方法 收集我院1970～1998年收治的子宫内膜癌患者238例,将所有病例按手术病理分期、病理类型和组织学分级分为低危、中危和高危三组,比较各种手术方式对各组患者预后的影响。结果 低、中危组主要行全子宫加双附件切除术或次广泛子宫切除术,各种术式生存率无显著差异(P>0.05)。高危组Ⅰa+Ⅰb期、Ⅰc期、Ⅱ期行次广泛(或广泛性)子宫切除附加盆腔淋巴结清扫术与单纯行次广泛子宫切除术相比,生存率差异无显著性(P>O.05)。Ⅲ、Ⅳ期主要行次广泛子宫切除术或广泛性子宫切除附加盆腔淋巴结清扫术,这两种术式的生存率差异无显著性(P>0.05)。结论Ⅰa+Ⅰb期腺癌可以单纯行全子宫加双附件切除术或次广泛子宫切除术。Ⅰa+Ⅰb期除腺癌外其他病理类型以及Ⅰc、Ⅱ期可以行广泛性子宫切除术附加盆腔淋巴结清扫术。Ⅲ、Ⅳ期患者预后差,手术方式对预后影响不大。     

手术及术后化疗治疗有复发中危和高危因素的ⅠB～ⅡA期宫颈癌68例疗效分析

目的:探讨宫颈癌根治术和盆腔淋巴结切除术及术后单纯化疗在有复发中危和高危因素的ⅠB～ⅡA期宫颈癌患者治疗中的效果。方法:选取在北京大学第一医院治疗的68例ⅠB～ⅡA期宫颈癌患者,初始治疗为宫颈癌根治术和盆腔淋巴结切除术,根据术后病理检查结果分为复发中危因素组(中危组)37例(侵犯宫颈深度>1/2宫颈厚度、低分化、肿瘤直径≥4cm、淋巴血管间隙受累)和复发高危因素组(高危组)31例(淋巴结转移、宫旁肿瘤侵犯、切缘阳性)。对所有患者术后辅助单纯化疗,中危组3～4个疗程,高危组4～6个疗程。宫颈鳞癌及腺鳞癌化疗为BIP方案(博来霉素+异环磷酰胺+顺铂/卡铂),腺癌化疗为TP方案(紫杉醇+顺铂/卡铂)。总结患者的3年累积无瘤生存率、复发率和手术及化疗的并发症及毒副反应。结果:37例中危组患者3年累积无瘤生存率为93.1%,31例高危组患者3年累积无瘤生存率为85.4%,两组比较,差异无统计学意义(P>0.05)。68例患者的总复发率为10.3%(7/68),中危组复发率为8.1%,高危组复发率为12.9%。中危组和高危组盆腔局部复发率分别为5.4%和6.5%。两组各项化疗毒副反应发生率比较,差异无统计学意义(P>0.05)。结论:宫颈癌手术及术后化疗对于有复发中危和高危因素的ⅠB～ⅡA期患者是一种可行的治疗选择,患者可耐受手术联合单纯化疗的并发症和毒副反应,并获得较好的近远期疗效。     

Ⅰ期子宫内膜癌不同术式疗效的研究

目的　对Ⅰ期子宫内膜癌不同术式的疗效及其术后并发症进行比较分析。方法　回顾性分析 1986年 1月至 1997年 12月手术治疗的 2 11例Ⅰ期子宫内膜癌 ,根据术式不同分为两组 ,61例采用全子宫加双侧附件切除术 (组 1) ,150例采用广泛性全子宫切除术 (组 2 )。对两组的疗效及术后并发症进行比较分析。结果　组 1和组 2总的 5年生存率分别为 96 0 %、93 5% ,两组比较 ,差异无显著性 (P >0 0 5) ;复发率分别为 6 6%、10 7% ,两组比较 ,差异无显著性 (P >0 0 5) ;术后并发症分别为 11 5%、2 4 7% ,两组比较 ,差异有显著性 (P <0 0 5)。结论　Ⅰ期子宫内膜癌患者可以采用全子宫加双侧附件切除术     

Surgical therapy of endometrial cancer

Surgery is generally accepted as the basis of therapy in endometrial carcinoma. In stage I disease with well-differentiated lesions (G I), the mainstay and generally accepted basis for management is surgical, usually extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy. In the cases of stage I and dedifferentiated lesions (G II/G III) bilateral pelvic lymphadenectomy is performed additionally. The surgical method in stage II lesions is radical abdominal hysterectomy, bilateral pelvic lymphadenectomy, and bilateral salpingo-oophorectomy.     

59例Ⅰ期子宫内膜癌的治疗分析

为探讨Ⅰ期子宫内膜癌更为合理的治疗方案，方法将５９例Ⅰ期子宫内膜癌患者随机分为两组：第１组３０例，单纯全子宫，双附件切除加辅助治疗；第２组２９例，行全子宫，双附件切除加盆腔淋续清扫或活检。结果第１组中死亡２例，２年和５年的存活率均为９６．６％平均生存６９．７个月。第２组中死亡３例。     

Evaluation of different surgical approaches in the treatment of endometrial cancer at FIGO stage I

From January 1, 1970 to December 31, 1979, 425 cases of endometrial carcinoma, FIGO stage I, were treated at the First Department of Obstetrics and Gynecology, University of Milan. Three different surgical approaches were used: total abdominal hysterectomy with bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy was performed in 245 women, total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy in 100, and vaginal hysterectomy with bilateral salpingo-oophorectomy in 80. Five-year survival was evaluated as a function of risk factors (histological grade, depth of myometrial invasion, metastatic nodes) in the three groups of patients, and we conclude that lymphadenectomy is useful for prognostic purposes but does not confer a therapeutic benefit.     

Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival.

OBJECTIVES: Our goal was to evaluate the morbidity, recurrence, and survival of patients with clinical stage I endometrial cancer treated by laparoscopic lymphadenectomy with vaginal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy.Study Design: This article is a retrospective review of records for 56 patients. The mean follow-up among those alive at last contact was 2.4 years (range, 32 days-5.2 years). Staging according to the International Federation of Gynecology and Obstetrics (1988) was as follows: I, 45 (80.4%); II, 3 (5.4%); III, 6 (10.7%); and IV, 2 (3.6%). RESULTS: Intraoperative complications occurred in 4 patients (7.1%). Transformation to laparotomy was necessary in 7 patients. Postoperative complications were observed in 9 patients (16.1%). Pelvic irradiation was administered postoperatively to 11 patients (19.6%). Among the 45 patients with surgical stage I disease, the 3-year recurrence rate was 2.5% and the 3-year cause-specific survival was 96.0%. CONCLUSIONS: Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy provided 3-year survival and recurrence rates similar to those of the traditional abdominal approach.     

The long-term survival of women with surgical stage II endometrioid type endometrial cancer

OBJECTIVES: The aim of this study was to evaluate the survival estimates, treatment outcomes, prognostic factors, and recurrence patterns of patients with surgical stage II endometrial cancer. METHODS: Forty-eight stage II endometrial cancer patients treated between 1982 and 2000 were included. All the patients were subjected to the initial surgical staging procedure consisting of peritoneal cytology, infracolic omentectomy, abdominal hysterectomy (radical or simple), bilateral salpingo-oophorectomy, and complete pelvic-paraaortic lymphadenectomy. Of these 48 patients, 21 (44%) were treated with radical hysterectomy (RH) without adjuvant therapy. The remaining 27 (56%) patients were treated with simple hysterectomy plus adjuvant radiotherapy. With respect to the prognostic factors, no statistically significant difference was found between these two groups. The median follow-up period was 5 years (range, 2-9). RESULTS: The mean age at the time of diagnosis was 55.8 years (range, 34-75). The 5-year disease-free and overall survival (OS) rates of entire group were 83% and 86%, respectively. These figures for 27 (56%) patients treated with simple hysterectomy plus radiation were 81% and 83%, respectively. For 21 (44%) patients who were treated with radical hysterectomy without adjuvant therapy, the 5-year disease-free and overall survival rates were 85% and 90%, respectively. When these two groups were compared, survival rates were not significantly different from each other (P = 0.60 for disease-free survival and P = 0.46 for overall survival). In multivariate analysis, only the high grade predicted poor survival significantly (P = 0.04). Eight patients (17%) had recurrence: two local, five distant, and one both local and distant. Initial therapeutic approach was not related with the subsequent site of relapse. Two patients with only local failure were successively treated, but all the six patients who had distant component of relapse died within the same year. Surgical morbidity was seen in six (12.5%) patients. No surgical mortality was seen, and no patient developed a major complication directly related to the radical hysterectomy or lymphadenectomy. CONCLUSIONS: Without adjuvant radiotherapy, initial surgical staging procedure consisting radical hysterectomy and complete pelvic-paraaortic lymphadenectomy achieved excellent survival and minimal morbidity in stage II endometrial cancer. Distant failure was the main problem.     

Evaluation of complete surgical staging with pelvic and para-aortic lymphadenectomy and paclitaxel plus carboplatin chemotherapy for improvement of survival in stage I ovarian clear cell carcinoma

OBJECTIVE: The aim was to determine the benefits of lymphadenectomy and paclitaxel plus carboplatin chemotherapy for stage I ovarian clear cell carcinoma (defined as intra-abdominal disease confined to the ovaries). METHODS: Twenty patients with stage I pure clear cell carcinoma of the ovary diagnosed between 1991 and 2001 were divided into two groups: Group A (12 patients, 1997-2001) underwent complete surgical staging including bilateral salpingo-oophorectomy, hysterectomy, omentectomy, and pelvic and para-aortic lymphadenectomy, followed by paclitaxel and carboplatin chemotherapy. Group B (8 patients, 1991-1996) underwent bilateral salpingo-oophorectomy, hysterectomy, and omentectomy without lymphadenectomy, followed by cisplatin-based chemotherapy. The survival of the two groups was compared. The clinical characteristics of the two groups were evaluated for age distribution, grade, substage, preoperative CA-125, presence or absence of endometriosis, and maximal tumor diameter. RESULTS: The estimated 4-year survival rate was 76.9%. The clinical characteristics of the two groups were similar, except for lymphadenectomy and regimen of chemotherapy. With a median follow-up of 36 months (range: 11-130 months), one of 12 patients in Group A had recurrence in comparison with 6 of 8 patients in Group B (P = 0.004). The estimated 3-year recurrence-free survival and 4-year overall survival for Group A was significantly greater than that for Group B (91.7 vs 33.3%, P = 0.014; 100 vs 50%, P = 0.014). Median time to recurrence was 8 months. CONCLUSIONS: Complete surgical staging, including pelvic and para-aortic lymphadenectomy and paclitaxel plus carboplatin chemotherapy, appeared to be capable of improving survival of patients with stage I ovarian clear cell carcinoma.     

Ⅰ期子宫内膜癌腹膜后淋巴结清除术的探讨

目的 探讨Ⅰ期子宫内膜癌的淋巴结转移率及行腹膜后淋巴结清除术的意义。方法 对３８例临床Ⅰ期子宫内膜癌临床、病理及随访资料呃生研究,对照分析经行腹膜后淋巴清除术后,未淋巴转移者２２例,ＦＩＧＯＩ期（Ａ组）,有淋巴结转移者６例,ＦＩＧＯ升级为ⅢＣ期（Ｂ组）及术行腹膜后淋巴清除扔１０例（Ｃ组）结果 经腹膜后淋巴清除术的患者中２１．４％有腹膜后淋巴结转移,因此期别应上升为ⅢＣ期,且腹膜后淋巴结转移与肿瘤细     

Prognostic factors in endometrial cancer

The 5 year survival rates of 228 patients with endometrial cancer treated in the period 1978-1982 according to the prognostic factors (stage, grade, depth of myometrial invasion, lymph node metastasis) is presented. All patients were treated with primary surgery consisting of classical Wertheim operation with lymphadenectomy (98 cases-43%), total abdominal hysterectomy with bilateral salpingo-oophorectomy with lymphadenectomy (52 cases-48%) and without lymphadenectomy (55 cases-52%) and vaginal hysterectomy with bilateral salpingo-oophorectomy (23 cases-10%). All patients except 6.6% were postoperatively irradiated. The 5 year survival for all stages was 74.6%. In SI cases it was 83.8%, in SII 57.9% and only 37.5% in SIII group. The survival was 90.1% in patients with superficial myometrial invasion and 56.4% in cases of deeper invasion. The survival of patients with node metastasis (8.6%) was only 39.5%, irrespective of the type of surgery and postoperative external irradiation. Vaginal recurrences were observed in 3.9%, and all the patients died. To improve the results it is necessary to individualize the treatment according to the pathologic and clinical prognostic factors.