子宫内膜癌诊治关注几个问题-妇产科课件PPT.ppt

王建六 北京大学人民医院妇产科;OUTLINE;子宫内膜癌09分期修订（1）;如何判断侵肌深度？;子宫内膜癌09分期修订（2）;为什么要删去细胞学检查？;子宫内膜癌09分期修订（4）;163 case 35 (21.5%) nodal metastases positive pelvic 26 (16.0%) aortic 24 (27.3%) Isolated aortic 17 (19.3%) The recurrence rate was higher (63.6%) among patients with upper aortic lymph node metastases all those who recurred died of disease within seven to 28 months. Eur J Gynaecol Oncol. 2007;28(2):98-102;子宫内膜癌标准术式 I期筋膜外子宫切除术？ II期广泛（改良的）子宫切除术？;筋膜内子宫切除术; 筋膜外子宫切除术;筋膜外子宫切除术;*; I期子宫内膜癌 GOG2010:Women with endometrial cancers should undergo total abdominal hysterectomy and BSO), pelvic/paraaortic dissection 妇科常见恶性肿瘤治疗指南：筋膜外子宫切除术 林巧稚妇科肿瘤学：全子宫切除术 妇产科学第七版（林仲秋）：筋膜外子宫切除术; 筋膜外子宫切除术？ 标准全子宫切除术？; 广泛子宫切除术 必要性？ 改良广泛（根治）子宫切除术 缩小的广泛子宫切除术？ （II型子宫切除术）;广泛子宫切除术目的：切除宫旁可能的转移 文献：样本例数较多的回顾性研究 Sartori E, et al. Int J Gynecol Cancer 2001;11(6):430~437 203 cases：10-Y OS 74% (TAH) vs 94%(RH) Boente MP,et al. Gynecol Oncol 1993;51(3):316~322. 202 cases：5-Y OS 77% (TAH) vs 86%(RH) Cornelison TL, Gynecol Oncol 1999;74(3):350~355. 932 cases：5-Y OS 84% (TAH) vs 93%(RH) OP alone 5-Y OS 83% (TAH) vs 88%(RH) OP+RT ;KOREA， JAPAN： Choose the surgical extent of hysterectomy through their own disposition and do not strictly adhere the results of pre operative evaluation. JAPANESE group more than 70% of institutes never perform RH without regarding the preoperative status of cervical involvement (Watanabe) NORTH AMERICAN：20%-30% center ;THIS IS AN AREA OF CONTINUED DEBATE！！ ;;;;;;早期：LND并未降低复发 改善生存;生存上没有差异;复发时间和复发率相似;;LND手术并发症明显增加;子宫内膜癌淋巴结切除利与弊争论“由来已久”！; I期患者真的可以不切除淋巴结吗？;有指征行腹膜后淋巴结切除术;TodoY et al. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010 Apr 3;375(9721):1165-72 ;ESMO2009;内分泌治疗必要性？;抗雌激素治疗-孕激素治疗;内分泌治疗对预后的影响;内分泌治疗对预后的影响;治疗时间与复发/转移的关系;子宫内膜癌内分泌治疗副作用 ;孕激素治疗禁用或慎用;子宫内膜癌内分泌治疗;问题依然是问题？ 疑问可能更多？ ;