262例宫颈癌淋巴结转移分布特点分析.docVIP

262例宫颈癌淋巴结转移分布特点分析 王利君 王武亮 袁博 毛丽丽 徐臻 郑州大学第二附属医院（郑州市 450014） 摘要 目的：分析宫颈癌淋巴结转移分布特点，探讨选择性盆腔淋巴结清扫的可行性。方法：回顾性分析我院行广泛性子宫切除加淋巴结清扫（包括208例常规淋巴结清扫和54例选择性闭孔和髂淋巴结清扫）的262例FIGOⅠb期和Ⅱ期宫颈癌患者的临床病例资料。结果：262例宫颈癌患者中，44例（16.7%）发生淋巴结转移，其中Ⅰ期19例（12.9%），Ⅱ期25例（21.7%）。所有淋巴结阳性者均有盆腔淋巴结转移，其中左侧16例，右侧11例，双侧17例，合并腹主动脉旁淋巴结转移者3例。淋巴结阳性者中,以闭孔淋巴结转移率最高（61.4%）,其余依次是髂内（38.6%）,髂外(20.5%),髂总(20.5%),腹股沟(13.6%)，宫旁（9.1%）和腹主动脉旁淋巴结(6.8%)。腹膜后淋巴结转移与临床分期、病理类型、肌层浸润深度、病灶大小以及病理分级有关，而与年龄无关。淋巴结转移个数≥3个者近期复发率高，预后差。结论：若无初程(闭孔或髂内)淋巴结转移，无常规行腹主动脉旁和腹股沟淋巴结清扫的必要；选择性闭孔和髂淋巴结清扫安全可行。 关键词 宫颈癌 盆腔淋巴结清扫 腹主动脉旁淋巴结 The characteristics of lymph node metastasis distribution for 262 cases cervical cancer WANG Li-jun WANG Wu-liang YUAN Bo MAO Li-li XU Zhen (The Second Affiliated Hospital Of Zhengzhou University, Zhengzhou,450014,China) ［Abstract］Objective：To analysis the characteristics of lymph node metastasis distribution for cervical cancer and explore the feasibility of selective pelvic lymph node dissection. Methods: 262 cases of FIGOⅠb and cervical cancer accepted surgical treatment (including 208 cases of conventional lymph node dissection and 54 cases selectively obturator node and iliac node dissection) were analyzed retrospectively. Results: Of all patients, 44 cases (16.7%) had lymph node metastasis, including 19 cases(12.9%)ofⅠ, 25 cases(21.7%)of stage Ⅱ.All node positive are pelvic lymph node metastasis, which left in 16 cases, right in 11 cases, bilateral in 17 cases, combined with para-aortic lymph node metastasis in 3 cases. The most common metastasis of cervical cancer occurred at the obturator lymph node (61.4%),and the others followed by iliac inside (38.6%), iliac outside (20.7%), iliac total (20.5%), inguinal (13.6%)，uterine beside lymph nodes(9.1%)and para-aortic lymph nodes (6.8%). Retroperitoneal lymph node metastasis was associated with the clinical stages, pathologic types, muscular layer infiltration depth, lesion size and pathologic stage , and with regardless of age. The prognosis of patients with ≥3 positiv