肿瘤细胞减灭术在晚期子宫内膜癌治疗中作用.docVIP

肿瘤细胞减灭术在晚期子宫内膜癌治疗中作用【摘要】 目的 目前晚期子宫内膜癌患者生存率低、生活质量差,治疗无定规方案。为探讨其治疗。方法 对我院7年来36例晚期子宫内膜癌患者临床资料进行回顾性分析。Ⅲ期1 6例,Ⅳ期20例。所有患者均给予以手术治疗为主的综合治疗,基本手术方式为广泛全子宫切除+双附件+大网膜、阑尾切除及盆、腹腔内转移病灶切除。结果 本组肉眼无残余病灶者10例,残余病灶2 cm者6例,手术满意率为83.3%(30/36)。随访至2008年12月,5年生存率仅为31.3%(5/16),3年生存率为54.2%(13/24),1年生存率为91.7%(33/36)。生存率与患者病变侵及范围、有无腹水、手术后残留病灶大小以及术后化疗周期长短等密切相关。结论 初步研究结果提示,提倡最大限度切除病灶减少肿瘤负荷,在理想的肿瘤细胞减灭术的基础上给予多疗程的联合化疗,而放射治疗的临床作用尚需进一步探讨。表明肿瘤细胞减灭术在晚期子宫内膜癌治疗中有重要价值。 【关键词】 子宫内膜肿瘤; 药物疗法; 肿瘤细胞灭减术 【Abstract】 Objective To observe the clinical value of cytoreductive surgery in advanced endometiral cacinoma.Methods A retrospective study was performed in 36 cases of advanced endometrial carcinoma who received cytoreductive surgery.All the patients including 16 cases of stage III and 20 cases of stage Iwere treated with combined therapy based on operation.The basic method included total hysterectomy,both adnexectomy,omentectomy,appendectomy and resection of metastatic lesion in abdominopelvic cavity.Results The content rate of operation was 83.3(30/36),including 10 cases of no unaided eyeresidual focus,20 cases of residual focus smaller than 2 cm and 6 cases of residual fucus larger than2 cm.To December 2007,the survival rates of,5 year,3 year and 1 year were 31.3(5/16),54.2-(13/24)and 91.7~(33/36),respectively.Conclusion The survival rate intimately correlated with the extent of disease,ascitcs,size of residual focus,circles of chemotherapy after the operation.In conclusion,cytoreductive sur gery bas an important value in advanced endometiral cacinoma.Multi-circle combined chemotherapy based on ideal cytoreductive surgery ix effective,while radiotherapy has no further therapeutic effect. 【Key words】 Garcinoma of endometrium; Drug therapy; Cytoreducine 肿瘤细胞减灭术是晚期卵巢癌患者的主要术式,而在子宫内膜癌中的应用少有报道。本研究对近7年来住院行肿瘤细胞减灭术的36例晚期子宫内膜癌患者的临床资料进行回顾性分析,以探讨晚期子宫内膜癌患者的有效治疗方法。 1 资料与方法 1.1 一般资料 2002年1月1日至2008年12月31日我院收治晚期子宫内膜癌患者36例,年龄42~78岁,中位年龄58.4岁。均行肿瘤细胞减灭术升有完整随访资料。按FIGO(2006)临床分期标准,Ⅲ期16例,Ⅳ期20例。病理类型:子宫内膜样腺癌22例,黏液性腺癌6例,