Elia G, Garfinkel D A, Goldberg G L, Davidson S, Runowicz C D
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, New York, USA.
Eur J Gynaecol Oncol. 1995;16(3):169-73.
To evaluate the role of extrafascial hysterectomy in the management of women with endometrial carcinoma and cervical involvement.
A review of 238 medical records of patients with endometrial cancer treated at the Weiler Hospital of the Albert Einstein College of Medicine and Montefiore Medical Center from 3/86 to 3/91 was performed. Thirty-one patients were selected based on histopathologic documentation of cervical involvement in the surgical specimen. Fisher exact probability test, Kaplan-Meier and Log-Rank procedures were used for the statistical analysis of the data.
Two patients were excluded as they received preoperative radiotherapy. Nineteen patients had Stage II disease and ten were found to have Stage III (two for positive washings, eight for positive pelvic and/or para-aortic nodes). Sixteen of 19 patients with Stage II disease received postoperative pelvic radiotherapy. Six patients with Stage III received postoperative radiotherapy, four with Stage III received chemotherapy. The probability of survival for Stage II patients was 72%, for Stage III 33% and the entire group was 60% (median follow-up 55 months).
Extrafascial hysterectomy was performed without major complications in 86% of patients with endometrial carcinoma and microscopic cervical involvement. This procedure may be considered an adequate first line of treatment for patients without gross cervical spread of the disease.
评估筋膜外子宫切除术在子宫内膜癌合并宫颈受累患者治疗中的作用。
回顾了1986年3月至1991年3月在阿尔伯特爱因斯坦医学院韦勒医院和蒙特菲奥里医疗中心接受治疗的238例子宫内膜癌患者的病历。根据手术标本中宫颈受累的组织病理学记录选择了31例患者。采用Fisher精确概率检验、Kaplan-Meier法和对数秩检验对数据进行统计分析。
2例患者因接受术前放疗而被排除。19例患者为Ⅱ期疾病，10例为Ⅲ期（2例冲洗液阳性，8例盆腔和/或腹主动脉旁淋巴结阳性）。19例Ⅱ期疾病患者中有16例接受了术后盆腔放疗。6例Ⅲ期患者接受了术后放疗，4例Ⅲ期患者接受了化疗。Ⅱ期患者的生存率为72%，Ⅲ期为33%，整个组为60%（中位随访55个月）。
86%的子宫内膜癌合并微小宫颈受累患者接受筋膜外子宫切除术后无严重并发症。对于疾病未出现宫颈大体播散的患者，该手术可被视为一种合适的一线治疗方法。
