子宫内膜癌手术病理分期的临床意义

目的 探讨子宫内膜癌手术病理分期的临床意义。方法 对我院1995年1月至1999年12月间初治为手术治疗的96例子宫内膜癌患者的临床资料进行回顾性分析，术前采用临床分期术后采用手术病理分期，对这两种分期方法进行比较。结果 两种分期不符合率为45．8％（44／96），其中临床Ⅰ期为24．0％（12／50），Ⅱ期76．9％（30／39），Ⅲ期为5例中2例。盆腔淋巴结转移率为10．3％（8／78），其中临床Ⅰb期为16例中1例，Ⅱ期14．7％（5／34）。子宫外盆腔转移率14．6％（14／96），其中临床Ⅰb期为19例中2例，Ⅱ期23．1％（9／39）。卵巢转移率9．4％（9／96），其中临床Ⅰa期为9．7％（3／31），Ⅱ期为10．3％（4／39）。腹腔冲洗液细胞学阳性率为7．9％（7／89），其中临床Ⅰ期为4．0％（2／50），Ⅱ期为10．3％（4／39）。大网膜转移率5．2％（5／96），阑尾转移率2．1％（2／96）。经单因素分析，临床分期、子宫肌层浸润深度、病理分级和组织学类型均与盆腹腔转移有关（P＜0．01，0．05）。经多因素相关分析，前3个因素间比较，差异有显著性（P＜0．05）。结论 手术病理分期较临床分期准确，临床分期尤其是临床Ⅱ期的误差率较高，临床处理上应予重视。子宫内膜癌盆腹腔转移与临床分期、子宫肌层浸润深度、病理分级密切相关。手术病理分期能客观判断预后，并指导治疗。Ⅲ

The clinical value of surgical-pathological staging for endometrial carcinoma

OBJECTIVE: To explore the practical value of surgical-pathological staging for endometrial carcinoma. METHODS: Ninety-six patients with endometrial carcinoma accepted primary surgical treatment from January 1995 to December 1999 were analyzed retrospectively in our hospital. The clinical and surgical pathologic staging of these patients were compared. RESULTS: The total differences between clinical and surgical-pathologic staging were 44 cases (45.8%), in stage I 24.0%, stage II 76.9%, in stage III 2 of 5 cases. The metastasis rate of pelvic lymph nodes was 10.3%, in stage I 1 of 16 cases, stage II 14.7%. Fourteen patients (14.6%) with extrauterine pelvic metastasis were found, of which 2 of 19 cases in stage I b, 23.1% in stage II. 9.4% with ovarian metastasis, in stage I a 9.7%, stage II 10.3%. 7.9% with positive peritoneal cytology, in stage I 4.0%, stage II 10.3%. 5.2% with omentum metastasis. 2.1% with appendix metastasis. Clinical stages, depth of myometrial invasions, pathological grades and histological types were related to the extent of pelvic and abdominal cavity by univariate analysis (P < 0.01, 0.05). The first three factors were significantly correlated to dissemination by multivariate (P < 0.05). CONCLUSIONS: The surgical-pathological staging is more accurate than the clinical staging, especial in stage II clinical stage depth of myoinvasion, patho-histological grades were closely related to the dissemination in pelvic-abdominal cavity. The surgical-pathological staging is able to assess prognosis objectively and guide therapy for endometrial carcinoma.