盆腹腔淋巴取样术在子宫内膜癌手术中的临床意义

目的探讨盆腹腔淋巴取样术在子宫内膜癌的临床意义。方法分析2000年1月-2007年12月上海同济大学附属第一妇婴保健院手术治疗的213例子宫内膜癌患者,其中,86例行盆腹腔淋巴取样术,127例行淋巴结切除术。手术方式根据手术切除淋巴结的情况分为两组。①取样组：淋巴取样术,筋膜外全子宫双附件切除/次广泛子宫切除术＋盆腔/腹主动脉旁淋巴结取样术86例;②切除组：次广泛/广泛子宫切除术＋盆腔淋巴结切除/腹主动脉旁淋巴结切除术127例。结果取样组：切除淋巴结中位数18枚,淋巴结的转移10例。切除组：切除淋巴结中位数32枚,淋巴结转移11例。5年生存率分别为94.2%和94.5%。取样组无病发症发生,淋巴结切除组中有9例,分别是1例术中大出血（〉2000ml）,淋巴囊肿感染6例,淋巴漏2例。结论在子宫内膜癌中淋巴结取样术可准确了解淋巴结的转移情况,适宜手术分期,并不影响生存率,是避免过度手术减少并发症发生的有效方法。

Clinical significance of sampling lymphadenectomy in endometrial carcinoma

Objective To study the clinical significance of pelvic and para-aortic regional sampling lymphadenectomy in endometrial carcinoma.Methods Data of 213 patients who underwent surgical treatment in our hospital from January 2000 to December 2008 were analyzed.The patients were divided into 2 groups based on the different lymph node dissection.The regional lymphadenectomy group included 86 patients who underwent an extrafascial hysterectomy or modified radical hysterectomy plus pelvic or para-aortic regional lymphadenectomy of the abdominal aorta, the dissection group included 213 patients who underwent radical or modified radical hysterectomy plus systemic pelvic lymph node clearance or par-aaortic lymph node dissection of the abdominal aorta.Results In the regional group, the median number of lymph nodes was 18 per case.Lymph node metastasis was found in 10 cases.In the dissection group,the median number of lymph nodes was 32 per case.Lymph nodemetastasis was found in 11 cases.The 5-year survival rate was 94.2%in the regional lymphadenectomy group and 94.5%in the dissection group.No complications occurred in regional lymphadenectomy groups, but in lymph node dissection group,there were totally 9 cases of complications, including 1 case of intraoperative bleeding (> 2 000 ml), 6 cases with lymphatic cyst infection and 2 cases with lymph leakage. Conclusions Using sampling lymphadenectomy can detect endometrial cancer lymphatic metastasis thus helpful for surgical staging. It causes less complications and dose not decrase the survival rate.