早期子宫内膜癌微创手术治疗已得到广泛认可,其基本术式为筋膜外全子宫切除术 + 双侧附件切除术 ± 盆腔 和腹主动脉旁淋巴结切除术或前哨淋巴结活检术。机器人手术系统克服了传统腹腔镜技术的操作瓶颈,使更多高龄、 大子宫、合并肥胖及严重粘连的患者获得微创治疗的机会,治疗结局无异于传统腹腔镜技术,这使得机器人辅助手 术应用于早期子宫内膜癌治疗具有较明显的优势。
Minimally invasive surgery has been widely used in the treatment of early endometrial cancer recognized. The basic surgical approach for early endometrial cancer is extrafascial total hysterectomy + bilateral adnexectomy and pelvic and /or abdominal aortic lymph node resection or sentinel lymph node biopsy. By breaking some technical limitations of conventional laparoscopic surgery, robotic surgical system enables more patients with advanced age, large uterus, combined obesity and severe adhesions to obtain minimally invasive treatment, and similar outcomes can be achieved, which makes advantages of robotassisted surgery in the treatment of early-stage endometrial cancer more obvious.
基金项目:国家自然科学基金(81960464);广西重点研发计划(AB22080045)
Foundation Item: National Natural Science Foundation of China (81960464); Key R&D Plan Project of Guangxi Zhuang Autonomous Region (AB22080045)
通讯作者:张师前,Email:r370012@126.com;范江涛,Email:jiangtao_fan1969@163.com
Corresponding Author: ZHANG Shiqian, Email: r370012@126.com; FAN Jiangtao, Email: jiangtao_fan1969@163.com
引用格式:中国医师协会微无创医学专业委员会妇科肿瘤学组,广西医学会妇产科学分会 . 机器人辅助手术治疗子宫内膜癌中国 专家共识(2025 年版):附手术视频 [J]. 机器人外科学杂志(中英文),2025,6(1):175-186.
Citation: Gynecologic Oncology Group of Minimally Invasive and Noninvasive Medicine Committee of CMDA, Obstetrics and Gynecology Branch of Guangxi Medical Association. Chinese expert consensus on robot-assisted surgery for endometrial cancer (2025): with surgical video[J]. Chinese Journal of Robotic Surgery, 2025, 6(1): 175-186.
[1] Siegel R L, Giaquinto A N, Jemal A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12-49.
[2] Forjaz G, Ries L, Devasia T P, et al. Long-term cancer survival trends by updated summary stage[J]. Cancer Epidemiol Biomarkers Prev, 2023, 32(11): 1508-1517.
[3] 赵湘铃 , 段朝晖 , 张敏 , 等 . 中国子宫内膜癌疾病负担状况及流 行趋势预测 [J]. 中国慢性病预防与控制 , 2023, 31(8): 568-573.
[4] 周蓉 , 王益勤 , 鹿群 , 等 . 早期子宫内膜癌保留生育功能治疗 专家共识 (2022 年版 )[J]. 中国妇产科临床杂志 , 2023, 24(2): 215-219.
[5] Makker V, MacKay H, Ray-Coquard I, et al. Endometrial cancer[J]. Nat Rev Dis Primers, 2021, 7(1): 88.
[6] Calle E E, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults[J]. N Engl J Med, 2003, 348(17): 1625-1638.
[7] Arthur R S, Kabat G C, Kim M Y, et al. Metabolic syndrome and risk of endometrial cancer in postmenopausal women: a prospective study[J]. Cancer Causes Control, 2019, 30(4): 355-363.
[8] FU H L, ZHANG J H, ZHAO S Y, et al. Survival outcomes of robotic-assisted laparoscopy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and metaanalysis[J]. Gynecol Oncol, 2023, 174: 55-67. DOI: 10.1016/ j.ygyno.2023.04.026.
[9] 范江涛 , 孙丹 , 张师前 . 机器人手术治疗子宫内膜癌中国专家共 识 (2021 版 )[J]. 机器人外科学杂志 ( 中英文 ), 2022, 3(5): 414-422.
[10] Schubert M, Mettler L, Deenadayal Tolani A, et al. Fertility preservation in endometrial cancer-treatment and molecular aspects[J]. Medicina (Kaunas), 2023, 59(2): 221.
[11] DAI Y B, WANG J Y, ZHAO L Y, et al. Tumor molecular features predict endometrial cancer patients’ survival after open or minimally invasive surgeries[J]. Front Oncol, 2021, 11: 634857. DOI: 10.3389/ fonc.2021.634857.
[12] 吴迪 , 李明霞 , 王楠 , 等 .333 例达芬奇机器人系统治疗子宫 内膜癌的病例系列分析 [J]. 解放军医学院学报 , 2021, 42(10): 1015-1019.
[13] Lechartier C, Bernard J, Renaud M C, et al. Robotic-assisted surgery for endometrial cancer is safe in morbidly and extremely morbidly obese patients[J]. Gynecol Oncol, 2023, 172: 15-20.DOI: 10.1016/ j.ygyno.2023.02.014.
[14] Raffone A, Travaglino A, Raimondo D, et al. Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta-analysis[J]. Int J Gynaecol Obstet, 2022, 157(1): 1-10.
[15] Collins A, Jacob A, Moss E. Robotic-assisted surgery in highrisk surgical patients with endometrial cancer[J]. Best Pract Res Clin Obstet Gynaecol, 2024, 92: 102421.DOI: 10.1016/ j.bpobgyn.2023.102421.
[16] 林珊珊 , 范江涛 . 机器人手术系统在妇科手术中的应用优势及 技巧 [J]. 实用妇产科杂志 , 2023, 39(10): 724-727.
[17] 谢玲玲 , 林仲秋 .《2024 NCCN子宫肿瘤临床实践指南 (第 1版 )》 解读 [J]. 中国实用妇科与产科杂志 , 2023, 39(11): 1122-1127.
[18] 许天敏 , 张师前 , 向阳 . 妇科手术术前评估与准备的中国专 家共识 (2022 年版 )[J]. 中国实用妇科与产科杂志 , 2022, 38(6): 622-627.
[19] 中华医学会妇产科分会病理学组 , 中国研究型医院学会超微与 分子病理学分会妇儿学组 . 子宫内膜癌保育治疗前后病理评估 专家共识 [J]. 中华病理学杂志 , 2022, 51(11): 1110-1114.
[20] Cancer Genome Atlas Research Network; Kandoth C, Schultz N, et al. Integrated genomic characterization of endometrial carcinoma [J]. Nature, 2013, 497(7447): 67-73.
[21] 中国抗癌协会妇科肿瘤专业委员会 , 中华医学会病理学分会 , 国家病理质控中心 . 子宫内膜癌分子检测中国专家共识 (2021 年版 )[J]. 中国癌症杂志 , 2021, 31(11): 1126-1144.
[22] Caprini J A. Thrombosis risk assessment as a guide to quality patient care[J]. Dis Mon, 2005, 51(2-3): 70-78.
[23] Kondrup J, Rasmussen H H, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials[J]. Clin Nutr, 2003, 22(3): 321-336.
[24] 徐帅 , 刘淑娟 , 王建六 , 等 . 妇科手术后盆腹腔粘连预防及诊 断的专家共识 (2020 年版 )[J]. 中国微创外科杂志 , 2020, 26(6): 481-488.
[25] Lundorff P, Brölmann H, Koninckx P R, et al. Predicting formation of adhesions after gynaecological surgery: development of a risk score[J]. Arch Gynecol Obstet, 2015, 292(4): 931-938.
[26] Scutiero G, Vizzielli G, Taliento C, et al. Influence of uterine manipulator on oncological outcome in minimally invasive surgery of endometrial cancer: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2022, 48(10): 2112-2118.
[27] Padilla-Iserte P, Lago V, Tauste C, et al. Impact of uterine manipulator on oncological outcome in endometrial cancer surgery[J]. Am J Obstet Gynecol, 2021, 224(1): 65.e1-65.e11.
[28] Eoh K J, Kim Y N, Nam E J, et al. Clinical relevance of uterine manipulation on oncologic outcome in robot-assisted versus open surgery in the management of endometrial cancer[J]. J Clin Med, 2023, 12(5): 1950.
[29] Quintana-Bertó R, Padilla-Iserte P, Lago V, et al. Endometrial cancer: predictors and oncological safety of tumor tissue manipulation [J]. Clin Transl Oncol, 2024, 26(5): 1098-1105.
[30] Sallée C, Lacorre A, Despoux F, et al. Use of uterine manipulator and uterine perforation in minimally invasive endometrial cancer surgery[J]. J Gynecol Obstet Hum Reprod, 2023, 52(7): 102621.
[31] 中国抗癌协会妇科肿瘤专业委员会 . 子宫内膜癌诊断与治疗指 南 (2021 年版 )[J]. 中国癌症杂志 , 2021, 31(6): 501-512.
[32] 范江涛 , 刘淑娟 , 孙丹 , 等 . 子宫内膜癌腹腔镜技术诊治指南 (2023 年版 )[J]. 中国实用妇科与产科杂志 , 2023, 39(3): 303-309.
[33] 中国研究型医院学会妇产科专业委员会 . 子宫内膜癌前哨淋 巴结切除临床应用专家共识 [J]. 中国妇产科临床杂志 , 2020, 21(4): 438-440.
[34] Stelloo E, Nout R A, Osse E M, et al. Improved risk assessment by integrating molecular and clinicopathological factors in early-stage endometrial cancer-combined analysis of the PORTEC cohorts [J]. Clin Cancer Res, 2016, 22(16): 4215-4224.
[35] Jamieson A, Thompson E F, Huvila J, et al. Endometrial carcinoma molecular subtype correlates with the presence of lymph node metastases[J]. Gynecol Oncol, 2022, 165(2): 376-384.
[36] Jamieson A, Huvila J, Chiu D, et al. Grade and estrogen receptor expression identify a subset of no specific molecular profile endometrial carcinomas at a very low risk of disease-specific death[J]. Mod Pathol, 2023, 36(4): 100085.
[37] Salehi S, Åvall-Lundqvist E, Legerstam B, et al. Robotassisted laparoscopy versus laparotomy for infrarenal paraaortic lymphadenectomy in women with high-risk endometrial cancer: a randomised controlled trial [J]. Eur J Cancer, 2017, 79: 81-89. DOI: 10.1016/j.ejca.2017.03.038.
[38] Lee H J, Lee Y H, Chong G O, et al. Comparison of robotic-assisted versus laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy in patients with endometrial cancer[J]. J Obstet Gynaecol Res, 2018, 44(3): 547-555.
[39] Feuer G, Briskin C, Lakhi N. Robotic omentectomy in gynecologic oncology: surgical anatomy, indications, and a technical approach [J]. J Robot Surg, 2023, 17(4): 1381-1391.
[40] 山东省临床肿瘤学会妇科肿瘤专家委员会 , 中国医师微无创医 学专业委员会妇科肿瘤学组 . 妇科肿瘤患者围手术期静脉血栓 栓塞症预防的专家共识 (2022 年版 )[J]. 中华肿瘤防治妇杂志 , 2022, 29(10): 687-694.
[41] 王雅卓 , 王延洲 , 王颖梅 , 等 . 妇科恶性肿瘤腹腔镜穿刺孔部位 转移中国专家共识 (2023 年版 )[J]. 中国实用妇科与产科杂志 , 2023, 39 (6): 626-632.
[42] 谢幸 , 孔北华 , 段涛 . 妇产科学 [M]. 第九版 . 北京 : 人民卫生出 版社 , 2019, 310.