经阴道子宫切除术时使用宫内操作器与子宫内膜癌淋巴管血管间隙浸润风险。
Intrauterine Manipulator Use During Minimally Invasive Hysterectomy and Risk of Lymphovascular Space Invasion in Endometrial Cancer.
出版信息
Int J Gynecol Cancer. 2018 Feb;28(2):208-219. doi: 10.1097/IGC.0000000000001181.
OBJECTIVE
This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy.
METHODS
A retrospective case-control study was conducted among stage I-IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI.
RESULTS
There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31).
CONCLUSION
Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.
目的
本研究旨在探讨在接受微创子宫切除术的子宫内膜癌患者中，宫内操作器（IUM）的使用与淋巴管血管间隙浸润（LVSI）的频率之间是否存在关联。
方法
对 2008 年至 2015 年间接受子宫切除术的 I 期-IV 期子宫内膜癌患者进行了回顾性病例对照研究。对患者的人口统计学、手术细节和肿瘤特征进行了病历回顾。比较了接受腹腔镜全子宫切除术（TLH）加 IUM 使用的女性和接受全腹部子宫切除术（TAH）的女性。为了调整 TLH-IUM 和 TAH 组之间的背景差异，对存档病历进行了数据收集和倾向评分匹配的回顾。进行了系统的文献综述和荟萃分析，以检查 LVSI 的频率。
结果
共有 687 名女性因子宫内膜癌接受了子宫切除术。其中，419 名女性接受了 TLH 加 IUM 使用，194 名女性接受了 TAH。最常见的 IUM 类型是 VCare（89.5%）。两组之间 LVSI 的频率无统计学差异：TLH-IUM 为 15.1%，TAH 为 19.9%（P=0.14）。在进行倾向评分匹配后，两组之间 LVSI 的频率相似：TLH-IUM 为 21.2%，TAH 为 19.6%（P=0.78）。系统的文献综述确定了 1371 例 TLH-IUM 和 1246 例 TAH 用于子宫内膜癌，两组之间 LVSI 的频率相似（15.0% vs 13.6%，P=0.31）。
结论
我们的研究表明，在接受微创子宫切除术治疗子宫内膜癌期间使用 IUM 不会增加 LVSI 的频率。
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