CAJ | 학술논문

背景与目的:淋巴结清扫术在子宫内膜癌治疗中的价值一直有争议,国内多数医院仅对部分高危型子宫内膜癌患者行淋巴结活检或选择性盆腔淋巴结切除术,罕有妇科医生对子宫内膜癌行系统的盆腔淋巴结清扫+腹主动脉旁淋巴结清扫.本文探讨系统的淋巴结清扫术在子宫内膜癌治疗决策中的价值以及手术的可行性.方法:回顾2005年1月-2008年7月在我院行系统的腹膜后淋巴结清扫术的128例子宫内膜癌,对其临床病理特点、淋巴结转移情况、术后治疗决策改变情况以及手术并发症进行分析.结果:128例患者中19例(14.8%)出现淋巴结转移,其中盆腔淋巴结转移15例(11.7%),腹主动脉旁淋巴结转移11例(8.6%),7例患者同时出现盆腔及腹主动脉旁淋巴结转移,4例患者仅有腹主动脉旁淋巴结转移.病理类型、组织学分化程度、肌层浸润深度以及淋巴血管间隙浸润与淋巴结转移相关(P<0.05).15例患者因淋巴结转移分期升级,术后需要辅以化疗和/或放疗;另50例中危、中高危早期患者因手术排除了子宫外转移免去术后辅助治疗.8例(6.3%)患者术后出现并发症,其中盆腔感染3例,阴道残端出血2例,不全性低位肠梗阻、深静脉血栓伴淋巴囊肿和腔隙性脑梗塞各1例.中位手术时间为150 min,中位出血量为300 mL,其中27例(21.1%)患者接受输血治疗.结论:在子宫内膜癌患者中行系统的淋巴结清扫是安全可行的,通过全面的手术分期可以明确淋巴结转移情况,准确提供预后相关信息,指导术后辅助治疗.
배경여목적:림파결청소술재자궁내막암치료중적개치일직유쟁의,국내다수의원부대부분고위형자궁내막암환자행림파결활검혹선택성분강림파결절제술,한유부과의생대자궁내막암행계통적분강림파결청소+복주동맥방림파결청소.본문탐토계통적림파결청소술재자궁내막암치료결책중적개치이급수술적가행성.방법:회고2005년1월-2008년7월재아원행계통적복막후림파결청소술적128례자궁내막암,대기림상병리특점、림파결전이정황、술후치료결책개변정황이급수술병발증진행분석.결과:128례환자중19례(14.8%)출현림파결전이,기중분강림파결전이15례(11.7%),복주동맥방림파결전이11례(8.6%),7례환자동시출현분강급복주동맥방림파결전이,4례환자부유복주동맥방림파결전이.병리류형、조직학분화정도、기층침윤심도이급림파혈관간극침윤여림파결전이상관(P<0.05).15례환자인림파결전이분기승급,술후수요보이화료화/혹방료;령50례중위、중고위조기환자인수술배제료자궁외전이면거술후보조치료.8례(6.3%)환자술후출현병발증,기중분강감염3례,음도잔단출혈2례,불전성저위장경조、심정맥혈전반림파낭종화강극성뇌경새각1례.중위수술시간위150 min,중위출혈량위300 mL,기중27례(21.1%)환자접수수혈치료.결론:재자궁내막암환자중행계통적림파결청소시안전가행적,통과전면적수술분기가이명학림파결전이정황,준학제공예후상관신식,지도술후보조치료.
Background and purpose: The role of lymphadenectomy for endometrial cancer is still controversial. Few gynecologists in China carry out pelvic and/or para-aortic lymphadenectomy for patients with endometrial cancer. The aim of the current study was to investigate the role of systematic lymphadenectomy in the treatment strategy of endometrial cancer and the feasibility in carrying out the surgery. Methods: We performed a retrospective chart review of all patients with endometrial cancer who experienced surgical staging at Cancer Hospital, Fudan University from January 2005 to July 2008. Lymph nodes metastatic status, alteration of adjuvant therapy and surgical complications were discussed. Results: Nineteen (14.8%) of 128 patients undergoing systematic lymphadanectomy had lymph node metastases: both pelvic and para-aortic in 7 patients, only pelvic in 8 patients, and exclusively isolated to the para-aortic area in 4 patients. Therefore, more than half of the patients with lymphatic dissemination had para-aortic lymph nodes metastases. Tumor grade, histological type, myometrial invasion and lymph-vascular space invasion were associated with lymph nodes metastases. Adjuvant chemotherapy and/or tumor-directed radiotherapy were needed for 15 patients upstaged due to lymph-nodal invasion (P<0.05). Furthermore, adjuvant therapy was eliminated for 50 intermediate/intermediate-high risk patients with negative lymph nodes and extrauterine spread. Complications were found in 8 patients: 3 pelvic infection, 2 residual vaginal bleeding, and 1 pero-bowel obstruction, 1 deep venous thrombosis accompanied with lymphocyst, and 1 lacunar infarction. The median time of the procedure was 150 minutes, median blood loss was 300 mL, and 27 patients received blood transfusion. Conclusion: The findings of the current study suggest that it is safe and feasible to carry out systematic lymphadenectomy in women with endometrial cancer. Surgical staging can assess the status of lymph nodes, provide accurate prognostic information, and help to formulate adjuvant therapy after surgery.