文档介绍：I期子宫内膜癌患者的循证治疗方案
(作者:___________单位: ___________邮编: ___________)
【摘要】目的通过一例I期子宫内膜癌患者的手术方式及是否需要行盆腔淋巴结清扫的问题,检索当前最佳临床证据,针对患者具体情况为治疗提供依据。方法根据循证医学的PICO 原则,提出问题,检索证据,对所获证据进行质量评价,并结合患者具体情况制定治疗方案。结果共纳入中、英文文献138篇,2个随机对照试验和3 篇临床指南。证据结果表明: 对于I期子宫内膜癌的手术方式及手术范围,目前并无大宗RCT提供证据,综合指南推荐、文献报道、临床经验及患者具体情况,该名患者手术方式目前仍推荐用腹式,并行盆腔淋巴结清扫术。结论对于I期子宫内膜癌的手术方式及范围,目前并无强有力的证据支持,需要遵循循证医学的原则,综合各方面因素考虑。
【关键词】子宫内膜癌;循证医学

Abstract: Objective To study an evidencebased treatment plan for a patient with stage I endometrial cancer. Methods According to the PICO (patient parison e) principle, the questions were introduced and the evidences were collected and critically assessed. The specific conditions of the patient were also taken into consideration to design the treatment plan. Results 138 Chinese and English articles, 2 random control trials and 3 clinical guidelines were involved. The collective evidences indicated that there were no RCT to provide evidences about the type and scope of surgery for stage I endometrial cancer. According to the treatment guidelines, article reports, clinical experience and the specific condition of the patient, laparotomic surgery and pelvic lymphadenectomy for this patient was mended. Conclusion There are no strong evidences for the type and scope of surgery for stage I endometrial cancer. Under the principle of evidencebased medicine, all aspects should be taken into consideration in the decision of treatment.
Key words: endometrial cancer;evidencebased medicine; PICO

子宫内膜癌(以下简称“内膜癌”)是女性生殖系统常见三大恶性肿瘤之一,约占女性癌症的7%,占女性生殖道恶性肿瘤的25%~35%。目前的调查显示,内膜癌的发病率呈上升趋势,发病年龄倾向年轻化。,,在女性恶性肿瘤居第七位,[1]。而到了2007年,[2]。在发达国家,内膜癌则已成为妇女生殖道恶性肿瘤中发病率最高的疾病,极大地威胁着广大妇女的健康。 2008年,中国卫生部公布的第三次全国死因调查结果表明,2004年~,已经超过宫颈癌,位居女性恶性肿瘤死亡率的第七位[3]。早期诊断和治疗可显著降低内膜癌患者的死亡率,Ⅰ%,而Ⅳ%[4]。本文主要探讨I期子宫内膜癌患者的循证治疗方案。
1 案例与提出问题

患者女性,59岁,因“绝经后不规则阴道流血1年”入院。体检:外阴、阴道、宫颈均正常,子宫增大,约9cm×8cm×5cm大小,双侧附件未扪及肿块。