腹腔镜手术中强化防溢出措施对IA期低级别子宫内膜癌预后的影响:回顾性队列研究
该回顾性队列研究纳入2012年1月至2022年6月在佛山市第一人民医院接受腹腔镜手术的IA期低级别子宫内膜样癌患者,根据是否严格执行无瘤措施分为强化无瘤组和常规组。优化无瘤切除策略可能有效降低术后总体复发率。
要点
- 强化无瘤措施组112例患者术后无复发。
- 8例患者死于肿瘤复发。
核心结论
- 优化无瘤切除策略可能有效降低IA期低级别子宫内膜样癌患者的术后总体复发率。
研究设计与样本
- 回顾性队列研究,纳入2012年1月至2022年6月在佛山市第一人民医院接受腹腔镜手术的IA期低级别子宫内膜样癌患者。
- 通过问卷将患者分为强化无瘤组(n=112)和常规组(n=305),所有外科医生均使用举宫器,关键区别在于子宫离断是否遵循严格规程以避免泄漏。
主要发现
- 强化无瘤组112例患者中未检测到复发。
- 8例患者死于肿瘤复发。
临床怎么用
- 在IA期低级别子宫内膜样癌的腹腔镜手术中,可考虑严格执行无瘤措施(如遵循严格规程离断子宫以避免肿瘤泄漏)以降低术后复发风险。
局限性
- 本研究为回顾性队列研究,分组基于问卷评估外科医生是否严格执行无瘤措施,可能存在选择偏倚和信息偏倚。
以上解读依据论文摘要(全文未开放获取或许可不允许翻译转载)。
原文
STUDY OBJECTIVE: To evaluate the impacts of laparoscopic enhanced preventive mesures against spillage on the postoperative recurrence rate and survival rate in patients with stage IA and low-grade endometrioid carcinoma. DESIGN: Retrospective cohort study. SETTING: The First People's Hospital of Foshan. PATIENTS: The study incorporated patients with stage IA and low-grade endometrioid carcinoma who underwent laparoscopic surgery from January 2012 to June 2022. INTERVENTIONS: A questionnaire was formulated to classify patients into the enhanced tumor-free group and the conventional group according to whether the surgeons rigorously implemented tumor-free measures. All surgeons utilized the uterine operator during the operation, and the most crucial factor was whether the uterine dissection conformed to strict protocols to avoid leakage. MEASUREMENTS AND MAIN RESULTS: No recurrence was detected in the enhanced tumor-free operation group(n = 112 patients). Thirteen of 305 (4.2%) patients in the conventional group suffered from recurrence. Among the recurrent cases, 9 were pelvic recurrences (six patients had a single recurrence site in the vaginal stump, and 3 had recurrences in the vagina along with other antomical locations), and 4 were distant metastases. Eight patients died from tumor recurrence. CONCLUSION: Optimized tumor-free resection strategies may effectively decrease the overall postoperative recurrence rate among patients with stage IA and low-grade endometrioid carcinoma.
引用
- Chen XR, Wang W, Luo XG, et al. Effects of Intensive Prevention of Spillage Measures During Laparoscopic Surgery on Prognosis in Stage IA and Low-Grade Endometrial Cancer: A Retrospective Cohort Study. J Minim Invasive Gynecol. 2026. PMID: 42144184. doi:10.1016/j.jmig.2026.05.002
供执业医师工作参考,不替代临床判断;数值与分级以指南原文为准。