子宫内膜癌治疗相关问题妇产科课件

子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科0909分期把累及宫颈内膜腺体归入分期把累及宫颈内膜腺体归入期期 子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科0909分期删去细胞学检查结果分期删去细胞学检查结果 子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科妇科常见肿瘤诊治指南 中华医学会妇科肿瘤分会 p49I期子宫内膜癌应行手术分期术式为筋膜外子宫切除术及双附件切除术 盆腔及腹主动脉旁淋巴结切除和（或）取样术术中如无明显淋巴结肿大，应系统切除淋巴结术中有可疑淋巴结肿大，取样明确有无转移即可腹主动脉旁淋巴结切除/取样指征：可疑淋巴结转移 特殊组织类型 CA125显著升高 宫颈受累深肌层受累 低分化子宫内膜癌淋巴结切除的必要性？子宫内膜癌治疗相关问题妇产科全国高等院校教材 妇产科学 乐杰主编 林仲秋编写 p275I期子宫内膜癌应行筋膜外子宫切除术及双附件切除术 盆腔及腹主动脉旁淋巴结切除和（或）取样术下列情况之一，应行盆腔及腹主动脉旁淋巴结切除和（或）取样术可疑淋巴结增大 宫颈受累 CA125显著升高特殊组织类型 癌灶累及宫腔面积超过50%低分化 深肌层受累 子宫内膜癌治疗相关问题妇产科Cochrane Database Syst Rev.2010 Jan 20;(1):CD007585.Lymphadenectomy for the management of endometrial cancer.May K,Bryant A,Dickinson HO,Kehoe S,Morrison J University of Oxford,Womens Centre No evidence that lymphadenectomy decreases the risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage I disease.The evidence on serious adverse events suggests that women who receive lymphadenectomy are more likely to experience surgically related systemic morbidity or lymphoedema/lymphocyst formation.子宫内膜癌治疗相关问题妇产科J Natl Cancer Inst.2008 Dec 3;100(23):1707-16.Epub 2008 Nov 25Systematic pelvic lymphadenectomy vs.no lymphadenectomy in early-stage endometrial carcinoma:randomized clinical trial.Rome,Italy CONCLUSION:Although systematic pelvic lymphadenectomy statistically significantly improved surgical staging,it did not improve disease-free or overall survival.子宫内膜癌治疗相关问题妇产科Lancet.2009 Jan 10;373(9658):125-36.Epub 2008 Dec 16.Efficacy of systematic pelvic lymphadenectomy in endometrial cancer(MRC ASTEC trial):a randomised study.Collaborators(180)Amos C,Blake P,Branson A,Buckley CH,Redman CW,Shepherd J,Dunn G,Heintz P,Yarnold J,Johnson P,Mason M,Rudd R,Badman P,Begum S,Chadwick N,Collins S,Goodall K,Jenkins J,Law K,Mook P,Sandercock J,Goldstein C,Uscinska B,Cruickshank M,Parkin DE,Crawford RA,Latimer J,Michel M,Clarke J,Dobbs S,McClelland RJ,Price JH,Chan KK,Mann C,Rand R,Fish A,Lamb M,Goodfellow C,Tahir S,Smith JR,Gornall R,Kerr-Wilson R,Swingler GR,Lavery BA,Chan KK,Kehoe S,Flavin A,Eddy J,Davies-Humphries J,Hocking M,Sant-Cassia LJ,Pearson S,Chapman RL,Hodgkins J,Scott I,Guthrie D,Persic M,Daniel FN,Yiannakis D,Alloub MI,Gilbert L,Heslip MR,Nordin A,Smart G,Cowie V,Katesmark M,Murray P,Eddy J,Gornall R,Swingler GR,Finn CB,Moloney M,Farthing A,Hanoch J,Mason PW,McIndoe A,Soutter WP,Tebbutt H,Morgan JS,Vasey D,Cruickshank DJ,Nevin J,Kehoe S,McKenzie IZ,Gie C,Davies Q,Ireland D,Kirwan P,Davies Q,Lamb M,Kingston R,Kirwan J,Herod J,Fiander A,Lim K,Head AC,Lynch CB,Browning AJ,Cox C,Murphy D,Duncan ID,Mckenzie C,Crocker S,Nieto J,Paterson ME,Tidy J,Duncan A,Chan S,Williamson KM,Weekes A,Adeyemi OA,Henry R,Laurence V,Dean S,Poole D,Lind MJ,Dealey R,Godfrey K,Hatem MM,Lopes A,Monaghan JM,Naik R,Evans J,Gillespie A,Paterson ME,Tidy J,Ind T,Lane J,Oates S,Redford D,Ford M,Fish A,Larsen-Disney P,Johnson N,Bolger A,Keating P,Martin-Hirsch P,Richardson L,Murdoch JB,Jeyarajah A,Lamb M,McWhinney N,Farthing A,Mason PW,Kitchener H,Beynon JL,Hogston P,Low EM,Woolas R,Anderson R,Murdoch JB,Niven PA,Kerr-Wilson R,Chin K,Flynn P,Freites O,Newman GH,McNally O,Cullimore J,Olaitan A,Mould T,Menon V,Redman CW,George M,Hatem MH,Evans A,Fiander A,Howells R,Lim K,Cawdell G,Warwick AP,Eustace D,Giles J,Leeson S,Nevin J,van Wijk AL,Karolewski K,Klimek M,Blecharz P,McConnell D.子宫内膜癌治疗相关问题妇产科 Hysterectomy and bilateral salpingo-oophorectomy(BSO)is the standard surgery for stage I endometrial cancer.Systematic pelvic lymphadenectomy has been used to establish whether there is extra-uterine disease and as a therapeutic procedure median follow-up of 37 months(IQR 24-58)191 women had died:88/704 standard surgery group 103/704 lymphadenectomy group251Recurrent disease 107/704 standard surgery group 144/704 lymphadenectomy group)子宫内膜癌治疗相关问题妇产科 INTERPRETATIONno evidence of benefit in terms of overall or recurrence-free survival for pelvic lymphadenectomy in women with early endometrial cancer.Pelvic lymphadenectomy cannot be recommended as routine procedure for therapeutic purposes outside of clinical trials.子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科33I I期子宫内膜癌期子宫内膜癌子宫切除范围：子宫切除范围：全子宫切除术？筋膜外子宫切除术？二者异同？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？次广泛子宫切除术？FIGO 2009 FIGO 2009 子宫内膜癌分期改变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？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？争议：局限于子宫，宫颈累及？广泛子宫切除术？子宫内膜癌治疗相关问题妇产科Disease limited to uterusMedically inoperable operableTumor directed RTTotal hysterectomy and bilateral salpingo-oophorectomyLympho nodes dissection pelvic+para aorticThe current NCCN Clinical Practice Guideline recommendspracticing radical hysterectomy only when cervical infiltrationis suspected on MRI or when confirmed by cervical biopsy.2009NCCN子宫内膜癌治疗相关问题妇产科 I 期子宫内膜癌期子宫内膜癌-手术方式手术方式子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科40分期分期改变改变带来带来的新的新问题问题子宫内膜癌治疗相关问题妇产科累及宫颈粘膜（累及宫颈粘膜（一期）一期）？子宫内膜癌治疗相关问题妇产科分段诊刮或宫腔镜检查分段诊刮或宫腔镜检查宫颈管阴性宫颈管阴性宫颈上皮浸润宫颈上皮浸润I 型子宫切除术型子宫切除术MR局限于颈管内膜局限于颈管内膜侵犯宫颈间质侵犯宫颈间质II或或III型子宫切除术型子宫切除术宫颈间质浸润宫颈间质浸润子宫内膜癌治疗相关问题妇产科子宫内膜癌治疗相关问题妇产科II期子宫内期子宫内膜癌手术方膜癌手术方式的选择式的选择子宫内膜癌治疗相关问题妇产科