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目的探讨Ⅰ期子宫内膜癌(EC))的手术方式以及术后激素治疗和放疗的必要性。方法对67例EC患者进行回顾性分析,其中Ⅰ期37例、Ⅱ期8例、Ⅲ期14例、Ⅳ期8例;根据手术方式不同,将Ⅰ期患者分为3组,行次广泛/广泛子宫及附件切除术和腹膜后淋巴结清扫术或腹膜后淋巴结取样术为A组(24例),行次广泛子宫及附件切除术为B组(5例),行全子宫及附件切除术和腹膜后淋巴结清扫术为C组(8例)。分析患者的生存情况,比较激素治疗、放疗对Ⅰ期患者预后的影响。结果寿命表法计算总体5年生存率为78.99%,Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率分别为88.65%、86.67%、77.92%和28.57%;细胞分级G3、深肌层侵犯、非子宫内膜样癌和淋巴结转移是影响预后的高危因素(P<0.05),Ⅰ期有高危因素组的5年生存率(80%)显著低于无高危因素组(100%),P<0.05;A、B和C组之间无明显生存差异(P>0.05),但A组手术方式有利于正确分期;Ⅰ期患者术后激素治疗的5年生存率(100%)显著高于无辅助性治疗对照组(86.67%),放疗(88.89%)与无辅助性治疗对照组之间无明显差异。结论A组手术方式可明确分期,指导治疗,但扩大的手术范围和腹膜后淋巴结清扫或取样不作为Ⅰ期患者的治疗手段,术后仍应给予恰当的辅助性治疗;激素治疗有利于改善Ⅰ期患者的预后,放疗的必要性则有待探讨。
Objective To investigate the surgical method of stage Ⅰ endometrial carcinoma (EC) and the necessity of postoperative hormone therapy and radiotherapy. Methods A total of 67 patients with EC were retrospectively analyzed. Among them, 37 patients were stage Ⅰ, 8 patients were stage Ⅱ, 14 were stage Ⅲ, 8 were stage Ⅳ. According to the different surgical methods, stage Ⅰ patients were divided into 3 groups, A wide range of uterine and annexectomy and retroperitoneal lymph node dissection or retroperitoneal lymph node sampling for the A group (24 cases), the line of extensive uterine and annexectomy for the B group (5 cases), the whole hysterectomy and attachment resection and Retroperitoneal lymph node dissection for the C group (8 cases). Analysis of the patient’s survival, hormone therapy, radiotherapy on the prognosis of patients with stage Ⅰ. Results The 5-year overall survival rate was 78.99% according to the life table method. The 5-year survival rates were 88.65%, 86.67%, 77.92% and 28.57% in patients with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively. , Non-endometrioid carcinoma and lymph node metastasis were the risk factors of prognosis (P <0.05). The 5-year survival rate (80%) of the high risk group was significantly lower than that of the non-risk group (100%), P <0.05. There was no significant difference in survival between groups A, B and C (P> 0.05), but the operation method in group A was conducive to correct staging. The 5-year survival rate (100%) of hormone therapy in stage I patients was significantly higher than There was no significant difference between the control group without adjuvant therapy (86.67%), radiotherapy (88.89%) and the control group without adjuvant therapy. Conclusion The operation mode of Group A can be clearly staged and guide the treatment. However, the extended surgical range and retroperitoneal lymph node dissection or sampling are not used as treatment for stage Ⅰ patients. Appropriate adjuvant therapy should be given after operation. Hormone therapy is beneficial to improve Ⅰ The prognosis of patients, the need for radiotherapy remains to be explored.