最新Ⅰ期子宫内膜癌子宫切除的范围-PPT文档.ppt
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1、1,I期子宫内膜癌 子宫切除范围:比较明确,存在混淆 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,子宫内膜癌分期改变,筋膜外子宫切除术?,II 期子宫内膜癌子宫切除范围?,子宫切除范围探讨OUTLINE,I期子宫内膜癌次广泛子宫切除术?,内膜癌病变局限于子宫-手术方式,Disease limited to uterus,Medically inoperable,operable,Tumor direct
2、ed 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
3、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. To
4、tal 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 mai
5、n factor influenced the survive of stage I endometrial carcinoma. Zhonghua Fu Chan Ke Za Zhi. 2004 Mar;39(3):156-8. The patients with stage I endometrial carcinoma who were treated with simple hysterectomy and salpingo-oophorectomy did almost as well as those who underwent radical hysterectomy.,为什么不
6、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,宫颈癌宫旁切除范围分类,子宫切除范围类型,Piver-Rutledge: 5类 LANCET 2008 :Denis Querleu, et al: Classification of radical hysterectomy,Extrafacial
7、hysterectomy Modified hysterectomy Radical hysterectomy Laterally extended resection Extenteration,筋膜外子宫切除术,目的 to ensure that the cervix is entirely removed 适应症:子宫内膜癌,早期宫颈癌 与全子宫切除术异同? 定义? 手术中要点?,筋膜外子宫切除术,方法: The position of the ureters is determined by palpation without freeing the ureters from thei
8、r beds. The parametrium is transected medial to the ureter, but lateral to the cervix, keeping the paracervical ring intact. The uterosacral and vesicouterine ligaments are transected close to the uterus. There is no removal of paracolpos and a minimal part of vagina is resected at fornix level.,9,筋
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