摘要
目的：对比分析子宫内膜癌的临床分期与手术病理分期的差异，探讨手术病理分期的优点及可行性。方法：回顾性分析１９８９～１９９５年收治的经手术治疗的子宫内膜癌患者２９０例的临床与病理资料，就其术前临床分期与术后手术病理分期进行比较，并分析了子宫内膜癌的分期及其预后因素。结果：临床分期误差率，Ⅰ期为１９．７％，Ⅱ期为８０．５％。临床分期Ⅰ期中淋巴结转移率为４．２％，腹腔细胞学阳性率为１０．６％。肌层浸润者占６０．５％。Ⅱ期中淋巴结转移率及腹腔细胞学阳性率分别为５１．４％和４６．９％，有肌层浸润者为１００．０％。发生分期误差的原因有：（１）术前不可能准确估计腹腔及淋巴结是否受累；（２）宫颈已受累但术前诊断性刮宫时漏刮，或宫颈未受累而误诊为阳性；（３）癌细胞播散于腹腔。结论：手术病理分期真实地反映了病变范围，建议在首次手术时除注意手术范围外，应重视腹腔冲洗液的收集及盆腔、腹主动脉旁淋巴结的取样或清扫，以确定期别，为术后辅助治疗选择及预后判断提供依据，鉴于Ⅱ期子宫内膜癌误诊率高，诊治上应特别给予重视。
Objective: To compare the differences between clinical (FIGO 1971) and surgical pathological (FIGO 1989) stagings of endometrial carcinoma and to investigate the advantage and the feasibi lity of the surgical pathological staging. Methods: Clinical and pathological data of 290 patients with endometrial carcinoma surgically treated from 1989 to 1995 were retrospectively reviewed. The clinical and surgical pathologic staging of these patients were compared. The stagings were analyzed with regards to the prognostic factors of endometrial cancer. Results: The differences between clinical and surgical pathologic staging in stage I and Ⅱ were 19.7% and 80.5% respectively. 4.2% with metastases to the lymph node, 10.6% with positive peritoneal cytology and 60.5% with myometrial invasion were found in clinical stage I. 51.4% with metastases to the lymph nodes, 46.9% with positive peritoneal cytology and 100.0% of myometrial invasion were observed in clinical stage Ⅱ. The causes of the differences between these two staging systems are: (1) it was impossible before operation to accurately detect metastases of the lymph nodes and malignant cells in the pelvic peritoneal cavity; (2) when the dilation and curettage was done before operation, the lesions of an involved cervix might be missed or an uninvolved cervix misdiagnosed as metastatic lesion; (3) there were already cancer cells disseminated in the peritoneal cavity. Conclusions: The surgical pathologic staging defines the real extent of endometrial carcinoma. It is advised that at the initial operation attention should be paid to areas beyond the extent of the intended surgery itself. During the initial operation, peritoneal cytology and pelvic and para aortic lymph node samplings should be done for the purpose of surgical pathologic staging of the selection of postoperative adjuvant therapy and of providing a clinico pathological basis for the prediction of prognosis. Since there is a high percentage of misdiagnosis in clinical stage Ⅱ endometrial carcinoma, special attention is needed in diagnosing and treating such patients.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
1997年第10期597-600,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
子宫内膜肿瘤
肿瘤分期
预后
Endometrial neoplasms Neoplasm staging Prognosis
