當子宮壁最內層的子宮內膜長出惡性腫瘤，稱為子宮內膜癌。治療上需切除子宮及雙側輸卵管與卵巢，並取骨盆腔淋巴結甚至腹主動脈淋巴結進行化驗，觀察有無轉移的可能。手術方式上，傳統開腹手術、腹腔鏡手術和達文西手術都可以完成；若是希望兼顧美觀與術後生活品質，達文西手臂能夠靈活的旋轉和彎曲動作，讓醫師在狹窄的空間，能更精準地進行分離、切斷及縫合，對後續預後和傷口復原有一定程度的幫助。
認識子宮內膜與子宮內膜癌
女性子宮壁由三層組織構成，由人體內而外依序排列：最內層稱子宮內膜，在中間的是平滑肌肉層，最外層叫漿膜層。子宮內膜每月增厚準備讓胚胎著床，若沒有胚胎則內膜會剝落形成月經。
一般子宮內膜癌患者年齡都超過 50 歲，因出現不尋常的陰道出血及分泌物、小便困難或不適、性交疼痛、下腹疼痛等症狀後，求診發現為子宮內膜癌。若是曾罹患子宮內膜增生的婦女，子宮內膜癌的機率也相對較高。
手術為子宮內膜癌的第一選擇
罹患子宮內膜癌，後續治療目前以手術拿掉子宮為最妥當安全的方法。因為長在子宮內膜的癌細胞，有可能隨著輸卵管向外擴散，因此部分陰道、雙側輸卵管、卵巢切除，骨盆腔及／或主動脈旁淋巴結也建議一併摘除，因此臨床上手術仍為治療子宮內膜癌的第一選擇。
達文西手術在初期子宮內膜癌的優勢
在初期子宮內膜癌的手術上，精準與靈活的微創達文西手臂手術仍占有相當優勢。與傳統開腹手術相比，微創手術住院天數、合併症與術後疼痛少；手術過程也因視野放大與 3D 視角，切除更加全面、術後不易沾黏。治療預後則和傳統開腹手術、微創手術差不多，並不會更容易復發。
目前大多進行子宮內膜癌手術的病人，若為初期子宮內膜癌者，都以有健保給付的腹腔鏡手術為第一選擇。考量手術切除的精準性及術後的恢復，患者可以進一步考慮達文西手臂手術；除非體質特殊或晚期癌症者，才會判定不適用上述微創手術。建議術前與醫療團隊討論諮詢，選擇出最適合的手術選項。
English Version｜Robotic Surgery for Endometrial Cancer
Endometrial cancer refers to a malignant tumour arising from the endometrium, the innermost layer of the uterine wall. Treatment involves removal of the uterus along with bilateral fallopian tubes and ovaries, together with sampling of pelvic and sometimes para-aortic lymph nodes to assess for metastasis.
The procedure can be performed via open surgery, conventional laparoscopy, or robotic-assisted surgery. For patients who wish to balance cosmetic outcome with post-operative quality of life, the robotic system offers articulated wrist movement that allows more precise dissection, transection, and suturing within confined spaces, which may benefit both recovery and wound healing.
Understanding the Endometrium and Endometrial Cancer
The uterine wall consists of three layers, from innermost to outermost: the endometrium, the smooth muscle layer (myometrium), and the serosa. The endometrium thickens each month in preparation for embryo implantation; if implantation does not occur, it sheds as menstruation.
Most patients with endometrial cancer are over 50 years old. They typically present with abnormal vaginal bleeding or discharge, urinary difficulty or discomfort, pain during intercourse, or lower abdominal pain. Women with a history of endometrial hyperplasia carry a relatively higher risk.
Surgery as First-Line Treatment
Surgical removal of the uterus remains the most appropriate and reliable treatment. Because malignant cells arising from the endometrium may spread through the fallopian tubes, removal of part of the vagina, bilateral tubes and ovaries, and pelvic and/or para-aortic lymph nodes is also generally recommended. Surgery therefore remains the first-line treatment in clinical practice.
Advantages of Robotic Surgery in Early-Stage Disease
For early-stage endometrial cancer, robotic-assisted minimally invasive surgery offers considerable advantages. Compared with open surgery, minimally invasive approaches are associated with shorter hospital stays, fewer complications, and less post-operative pain. The magnified 3D view allows more thorough resection with a lower likelihood of adhesion formation. Oncologic outcomes are comparable to those of open and conventional laparoscopic surgery, with no increased risk of recurrence.
For most patients with early-stage endometrial cancer, conventional laparoscopy — covered by Taiwan’s National Health Insurance — remains the first option. Patients who prioritise surgical precision and post-operative recovery may further consider robotic-assisted surgery. Minimally invasive approaches may not be suitable for patients with particular anatomical considerations or advanced-stage disease. A discussion with your medical team before surgery is recommended in order to determine the most appropriate option.
婦科腫瘤與子宮內膜癌微創手術評估
- 陳威君醫師｜婦科腫瘤／婦癌專科・副教授級主治醫師
- 專長：海扶刀、單孔達文西微創手術、微波消融治療
- 門診：林口長庚紀念醫院、土城長庚紀念醫院
- 門診諮詢｜LINE 搜尋：@hifudr
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