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目的:分析子宫内膜癌的临床及病理特征。方法:回顾性分析2000-2014年广州市番禺区中心医院收治的536例子宫内膜癌患者的临床资料。结果:子宫内膜癌平均发病年龄(51.16±7.84)岁;初潮早、晚绝经比例分别为1.4%、36.8%;合并不孕、未产比例分别为1.7%、5.8%;合并糖尿病、高血压比例分别为5.8%、16.0%;合并多囊卵巢综合征比例为1.3%。异常子宫出血436例(82.0%),是最常见的首发症状;手术前误诊/漏诊率为9.5%(51/536);手术-病理分期Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期分别占75.0%、8.8%、13.6%、2.6%;Ⅰ型、Ⅱ型子宫内膜癌分别占98.2%、1.8%;G1、G2、G3分别占37.8%、50.6%、11.6%;无/浅肌层浸润、深肌层浸润分别占78.2%、21.8%;淋巴结转移率为15.8%(47/297)。单因素分析结果提示,G3、淋巴脉管间隙受累、深肌层浸润、宫颈间质浸润、附件转移是淋巴结转移的高危因素(P<0.05);多因素分析结果提示,深肌层浸润、G3、宫颈间质浸润是影响淋巴结转移的独立高危因素(P<0.05)。结论:异常子宫出血是子宫内膜癌最常见的首发症状,对于合并有高危因素的患者,要引起足够的重视,完善相关检查,减少漏诊/误诊发生。Ⅱ型子宫内膜癌的发病年龄相对较高,容易出现Ⅲ/Ⅳ期、组织学分级中-低分化、深肌层浸润、淋巴结转移。深肌层浸润、G3、宫颈间质浸润是淋巴结转移的独立高危因素。
Objective: To analyze the clinical and pathological features of endometrial cancer. Methods: The clinical data of 536 patients with endometrial cancer who were treated in Central Hospital of Panyu District from 2000 to 2014 were retrospectively analyzed. Results: The average age of onset of endometrial cancer was (51.16 ± 7.84) years old. The rates of menarche and early menopause were 1.4% and 36.8%, respectively. The rates of infertility and unproductive infertility were 1.7% and 5.8% respectively. Combined with diabetes mellitus and hypertension The proportions were 5.8% and 16.0%, respectively. The proportion of polycystic ovary syndrome was 1.3%. Abnormal uterine bleeding in 436 cases (82.0%) was the most common first symptom. The rate of misdiagnosis / misdiagnosis before operation was 9.5% (51/536). Surgical-pathological stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 75.0 %, 8.8%, 13.6% and 2.6% respectively. Type Ⅰ and type Ⅱ endometrial carcinomas accounted for 98.2% and 1.8% respectively; G1, G2 and G3 accounted for 37.8%, 50.6% and 11.6% , Deep myometrial invasion accounted for 78.2%, 21.8% respectively; lymph node metastasis rate was 15.8% (47/297). Univariate analysis revealed that G3 and lymphovascular space involvement, deep myometrial invasion, cervical interstitial infiltration and attachment metastasis were risk factors for lymph node metastasis (P <0.05). Multivariate analysis suggested that deep myometrial invasion, G3 , Cervical interstitial infiltration is an independent risk factor for lymph node metastasis (P <0.05). Conclusion: Abnormal uterine bleeding is the most common first symptom of endometrial cancer. For patients with high risk factors, enough attention should be given to improve the related examination and reduce the missed diagnosis / misdiagnosis. Type II endometrial cancer is relatively old, prone to stage III / IV, histological grading - poorly differentiated, deep myometrial invasion, lymph node metastasis. Deep myometrial invasion, G3, cervical interstitial infiltration is an independent risk factor for lymph node metastasis.