关键词: 结直肠肿瘤, 遗传性非息肉性, 子宫内膜肿瘤, 子宫切除术, 暴露后预防

Abstract: Objective　To explore the clinical features and prognosis of prophylactic hysterectomy （PH） verus nonprophylactic hysterectomy（NPH） in patients with Lynch syndrome（LS）and Lynch syndrome-associated endometrial cancer（LS-EC），with a view to providing a reference for the treatment and prognosis improvement of this disease.Methods　16 patients with LS and 22 patients with LS-EC were involved from the First Hospital of Hebei Medical University from December 2014 to October 2016.Among them，16 voluntarily underwent PH （PH group），and other 22 underwent NPH（NPH group）．The baseline characteristics，results of quality of life assessment，histopathology and gene mutation analysis as well as survival rate of the two groups were collected.Results　Two groups showed significant differences in the time between diagnosis and surgery，and prevalence of symptoms associated with endometrial cancer（EC） （P<0.05）．With regard to histopathological findings，in the PH group，10 were found with abnormal results，including 5 with EC，3 with diffuse endometrial hyperplasia，1 with clear-cell endometrial cancer，and 1 with focal endometrial hyperplasia；the other 6 were found without endometrial cancer，including 3 with mild endometrial hyperplasia，2 with uterine fibroids，and 1 with uterine membrane atrophy；in the NPH group，19 were identified with endometrioid adenocarcinoma，2 with mucinous endometrial adenocarcinoma，1 with serous endometrial cancer；tumor location，status of lymph node metastasis，pathological type，pathological grading of endometrioid adenocarcinoma，and status of uterine muscle layer infiltration were similar in EC patients of both groups（P>0.05），but tumor diameter was less in EC patients of PH group（P<0.05）．Gene mutation analysis revealed that the mutation rates of hMSH2，hMSH6 and hPMS2 were similar in both groups（P>0.05），but mutation rate of hMLH1 was much higher in the PH group（P<0.05）．Up to 2017-03-01，27 survived and 11 died in all patients；PH group had higher survival rate than NPH group （χ2=4.900，P=0.027）．Conclusion　LS patients are usually accompanied by a history of cancer，and from diagnosis to longer operation time，but it can be reduced by PH.

Key words: Colorectal neoplasms, hereditary nonpolyposis；Endometrial neoplasms；Hysterectomy；Post-exposure prophylaxis