子宫内膜癌治疗相关问题-妇产科课件演示课件.pptVIP

Todo Y 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  671 patients with endometrial carcinoma systematic pelvic lymphadenectomy (n=325) pelvic and para-aortic lymphadenectomy (n=346) INTERPRETATION: Combined pelvic and para-aortic lymphadenectomy is recommended as treatment for patients with endometrial carcinoma of intermediate or high risk of recurrence. Ⅰ期子宫内膜癌子宫切除范围 * I期子宫内膜癌 子宫切除范围： 全子宫切除术？筋膜外子宫切除术？二者异同？ 次广泛子宫切除术？ FIGO 2009 子宫内膜癌分期改变 影响子宫内膜癌子宫切除范围的选择吗？ 局限于子宫的内膜癌手术选择 争议：局限于子宫，宫颈累及？广泛子宫切除术？ 子宫切除范围值得探讨 内膜癌病变局限于子宫--手术方式 Disease limited to uterus Medically inoperable operable Tumor directed RT Total hysterectomy and bilateral salpingo-oophorectomy Lympho nodes dissection pelvic+para aortic The current NCCN Clinical Practice Guideline recommends practicing radical hysterectomy only when cervical infiltration is suspected on MRI or when confirmed by cervical biopsy. 2009NCCN FIGO: 筋膜外子宫切除术 GOG2010:Women with endometrial cancers should undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-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 中国妇产科学（曹泽毅主编）：筋膜外子宫切除术 I 期子宫内膜癌--手术方式 I 期子宫内膜癌--手术方式 Gan To Kagaku Ryoho. 1995 Aug;22(9):1163-8. Total hysterectomy is done for cases of stage 0, modified radical hysterectomy for stage I, radical hysterectomy for stage II, and radical hysterectomy combined with resection of the metastatic lesions for stage III and IV Zhonghua Fu Chan Ke Za Zhi. 2002 Feb;37(2):90-3. Surgical method is not the main factor influenced the survive of stage I endometrial carcinoma. 为什么不行广泛或次广泛子宫切除术 Mauro?Signorelli, et al. Gynecologic Oncology 2009 Modified Radical Hysterectomy Versus Extrafascial Hysterectomy in the Treatment of Stage I Endometrial Cancer Recurrence ? Class I hysterectomy(n =?263) Class II hysterectomy(n?=?257) NO recurre