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目的探讨分期手术治疗子宫内膜癌的临床价值。方法对1990 年至2002 年我院首选分期手术(S O 组)和全子宫加双附件切除术(H B S O 组)治疗的253 例临床Ⅰ、Ⅱ期子宫内膜癌的临床病理资料进行回顾性分析。结果①临床Ⅰ期的HBSO 组与SO 组5 年生存率分别为86.16%及84.75%；临床Ⅱ期的HBSO 组与SO 组5 年生存率分别为70.33%及72.12%，两组无显著性差异(P 均＞0.05)。两种术式比较，HBSO 组明显比SO 组的平均手术时rrrrrrrrn间短，平均出血量少(P 均<0.01)，手术并发症少(P <0.05)；②14 例复发病例中8 例远处转移，6 例为盆腔复发。转rrrrrrrrn移、复发与术式有关，其中HBSO 组局部复发率明显高于SO 组(P <0.01)；③淋巴结转移者的5 年生存率42.31%，明rrrrrrrrn显低于无转移者的75.57%(P <0.01)。淋巴结转移率与宫颈受侵、肌侵＞1／2 、特殊病理类型、组织低分化(G 3 )显著相关。结论①子宫内膜癌行淋巴清扫术，使手术时间延长、出血量增多、手术并发症增加，但不能显著提高生存率；rrrrrrrrn②临床Ⅰ期宜行筋膜外子宫切除术，临床Ⅱ期则宜行广泛性子宫切除术以减少盆腔局部复发；③淋巴结转移是影响预后的高危因素，具有高危因素者除手术和放疗外应辅助化疗。
Objective To investigate the clinical value of staged surgery for endometrial cancer. Methods The clinicopathological data of 253 cases of clinical stage Ⅰ and Ⅱ endometrial carcinoma from 1990 to 2002 were analyzed retrospectively in the patients with stage S O and stage H B S O. Results The 5-year survival rates of HBSO group and SO group were 86.16% and 84.75% respectively. The 5-year survival rates of HBSO group and SO group in clinical phase Ⅱ were 70.33% and 72.12% respectively. There was no significant difference between the two groups (P> 0.05). Compared with the average operation time of the SO group, the average time of operation in the HBSO group was shorter and the average amount of bleeding was less (P <0.01) Disease less (P <0.05); ② 14 cases of recurrence in 8 cases of distant metastasis, 6 cases of pelvic recurrence. The recurrence rate was significantly higher in HBSO group than that in SO group (P <0.01). ③ The 5 The annual survival rate was 42.31%, which was significantly lower than 75.57% (P <0.01) of those without metastasis. The rate of lymph node metastasis and cervical invasion, muscle invasion> 1/2, a special pathological type, poorly differentiated (G 3) were significantly correlated. Conclusions ① Lymphadenectomy of endometrial carcinoma prolongs the operation time, increases the amount of bleeding and increases the complication of operation, but does not significantly improve the survival rate. Clinical stage Ⅰ should be extra-fascicular hysterectomy, clinical stage Ⅱ should be performed extensive hysterectomy to reduce pelvic local recurrence; ③ lymph node metastasis is a risk factor for prognosis, with high risk factors in addition to surgery and radiotherapy should be supplemented Chemotherapy.