晚期子宫内膜癌患者手术治疗的价值

目的 探讨手术治疗在晚期(Ⅲ～Ⅳ期)子宫内膜癌患者中的应用价值.方法 对1997年1月1日至2007年12月31日间在山东省肿瘤医院妇瘤科住院行手术治疗的78例晚期子宫内膜癌患者的临床资料进行回顾性分析.其基本手术方式为子宫全切除+双侧附件切除+部分大网膜切除+阑尾切除+盆腹腔内转移灶切除术,以残留灶直径≤2 cm者为手术满意.评价晚期子宫内膜癌手术治疗的效果(随访满1、3、5年者分别为67、51、36例),并分析影响患者预后的因素.结果 78例患者中,肉眼无残留灶者23例,残留灶直径≤2 cm者42例,残留灶直径＞2 cm者13例,手术满意率为83%(65/78).患者1年生存率为91%(61/67),3年生存率为55%(28/51),5年生存率为28%(10/36).单因素分析显示,肿瘤侵及范围、有无腹水、术后残留灶大小、术后化疗疗程数明显影响患者的预后(P＜0.05);而病理类型、有无术后放疗对患者预后无明显影响(P＞0.05).结论 手术治疗在晚期子宫内膜癌患者的治疗中有重要价值,应提倡最大限度切除病灶,在此基础上给予多疗程的联合化疗,而放疗的意义不大.

Surgical treatment in advanced endometrial carcinoma

Objective To study the clinical value of operation in advanced endometrial carcinoma.Methods A retrospective study was carried out in 78 patients with advanced endometrial carcinoma received operation in our hospital from Jan.1,1997 to Dec.31,2007.The basic operation procedures were included total hysterectomy,adnexectomy,omentectomy,appendectomy and resection of metastatic lesions located in abdomino-pelvic cavity.The criteria of satisfied operation Was considered that the sizes of residual leision was smaller than or equal to 2 cm,which Was used to evaluate the effect of operation.The prognostic factors were also analyzed.Results Among the 78 cases,the rate of ideal cytoreductive surgery was 83%(65/78),included 23 cases of no residual leisions,42 cases of residual leisions size smaller than or equal to 2 cm,while 13 cases of residual leisions size larger than 2 cm.The Survival rate of 1-year,3-year and 5-year were 91%(61/67),55%(28/51)and 28%(10/36),respectively.The results by single factor analysis shown that the survival rate were correlated with prognostic factors included extent of disease,ascites,size of residual lesions,circles of chemotherapy.Conclusion It is important value for advanced endometrial carcinoma to ideal cytoredutive surgery followed by combined chemotherapy,while radiotherapy no further therapeutic effects.