有關(guān)子宮內(nèi)膜癌手術(shù)的思考(編輯修改稿)
2025-06-22 12:08 本頁面
【文章內(nèi)容簡介】 % ? 中危： G2 或 G3 和 /或肌層浸潤不超過 1/2 ?淋巴結(jié)轉(zhuǎn)移的機(jī)會(huì)為 2% to 6% ? 低危： G1和沒有肌層浸潤 ?沒有淋巴結(jié)轉(zhuǎn)移 Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group study. Cancer. 1987。60(8 suppl):20352041 淋巴結(jié)切除的手術(shù)質(zhì)量 ? 目前沒有統(tǒng)一的手術(shù)標(biāo)準(zhǔn) ? 和手術(shù)醫(yī)生、手術(shù)方法以及病理醫(yī)生關(guān)系密切 ? 通常認(rèn)為 ? 腹股溝淋巴結(jié)每側(cè) : 510個(gè) ? 盆腔 : ?活檢 10個(gè) ?取樣 1015個(gè) ?淋巴結(jié)切除 20個(gè) ? 腹主動(dòng)脈旁淋巴結(jié) :1015個(gè) 最低標(biāo)準(zhǔn) 淋巴結(jié)切除的質(zhì)量和預(yù)后相關(guān) ? Chan的研究發(fā)現(xiàn) ? 對于 I期（中危和高危） 切除淋巴結(jié)的數(shù)目多伴有更好的 5年生存率 ? 對于 IIIC–IV期患者 淋巴結(jié)切除的越徹底預(yù)后改善越明顯 ? 對于 I期、 G3的患者 全面分期手術(shù)明顯改善生存 Chan JK, Cheung MK, Huh WK, et al. Therapeutic role of lymph node resection in endometroid corpus cancer: a study of 12,333 patients. Cancer. 2022。107(8):18231830. Chan JK, Wu H, Cheung MK, et al. The outes of 27,063 women with unstaged endometrioid uterine cancer. Gynecol Oncol. 2022。106(2): 282288. 淋巴結(jié)切除和預(yù)后 ?研究發(fā)現(xiàn) 手術(shù)中切除肉眼轉(zhuǎn)移的淋巴結(jié) 是可以改善患者的預(yù)后的 Havrilesky LJ, Cragun JM, Calingaert B, et al. Resection of lymph node metastases influences survival in stage IIIC endometrial cancer. Gynecol Oncol. 2022。99(3):689695. Epub 2022 Aug 29. Fujimoto T, Nanjyo H, Nakamura A, et al. Paraaortic lymphadenectomy may improve diseaserelated survival in patients with multipositive pelvic lymph node stage IIIc endometrial cancer. Gynecol Oncol. 2022。107(2):253259. Epub 2022 Jul 19. 淋巴結(jié)切除和預(yù)后 ?淋巴結(jié)切除的范圍與預(yù)后密切相關(guān) Kilgore LC, Partridge EE, Alvarez RD, et al. Adenocarcinoma of the endometrium: survival parisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995。56:2933. COSANZUK COSANZUK endometrial cancer study group. Pelvic lymphadenectomy in high risk endometrial cancer. Int J Gynecol Cancer 1996。6:1027) 淋巴結(jié)切除和預(yù)后 ? 盆腔及腹主動(dòng)脈旁淋巴結(jié)切除明顯改善生存，并且減少腹膜后復(fù)發(fā) Chuang L, Burke TW, Tornos C et al: Staging laparotomy for endometrial carcinoma : assessment of retroperitoneal lymph nodes. Gynecol Oncol 58:189, 1995 Mohan DS, Samuels MA, Selim MA, et al. Longterm outes of therapeutic pelvic ... Gynecol Oncol. 1998。70:165–71 Mariani A, Webb MJ, Galli L, et al: Potential therapeutic role of paraaortic ... Gynecol Oncol 76:348356, 2022 淋巴結(jié)切除和預(yù)后 ? 淋巴結(jié)切除是子宮內(nèi)膜癌的標(biāo)準(zhǔn)治療，并可減少外照射的應(yīng)用 Orr JW Jr, Holimon JL, Orr PF. Stage I corpus cancer: is teletherapy necessary? Am J Obstet Gynecol. 1997。176:777789 Podratz KC, Mariani A, Webb MJ. Staging and
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