子宫内膜癌淋巴结转移规律及手术范围探析.docVIP

子宫内膜癌淋巴结转移规律及手术范围探析 　【关键词】 子宫 摘要： 目的： 探讨子宫内膜癌淋巴结转移规律及手术范围。方法： 对接受全子宫、盆腔淋巴结切除的180例子宫内膜癌患者，准确记录肿瘤所处子宫腔位置、子宫肌层浸润深度 、分期、病理类型、细胞学分级、切除淋巴结位置、总数及阳性淋巴结数。分析淋巴结转移规律及手术范围。结果： 位于宫底部、宫体部、累及宫颈者子宫内膜癌淋巴结转移率分别是20%、21%、37.7%，均以髂外淋巴结为最常见的转移部位。病灶局限于宫底、宫体部者多为髂外、闭孔淋巴结转移；累及宫颈者以髂外、髂总淋巴结转移为常见。前者髂总淋巴结转移率为25%，后者为70.6%，P＜0.01。所有腹主动脉旁淋巴结阳性和累及宫颈者的髂总淋巴结均为阳性，而病灶限于宫体的腹主动脉旁淋巴结转移者仅有30%髂总淋巴结阳性。肌层浸润程度、病理类型及细胞分化程度与盆腔淋巴结转移密切相关。结论： 位于宫体部的肿瘤可直接或由宫颈转移至髂外淋巴结，宫颈受累者最易发生髂总和髂外淋巴结转移。病灶累及宫颈者髂总淋巴结可作为腹主动脉旁淋巴结的前哨淋巴结。Ⅰ期、G1、局限于子宫内膜的癌肿可仅行全子宫切除。 关键词：子宫内膜肿瘤；淋巴结转移；手术 Study on Regularity of Lymph Nodal Metastasis and Surgical Operation Scope on Patients with Endometrial Cancer Abstract: Objective: To study the way of the nodal distribution and surgical operation in endometrial carcinoma.Method: 180 cases with endometrial cancer treated by hysterectomy and pelvic lymphadenectomy were reviewed and analyzed .Position、invasive degree、staging、pathologic type、cytodifferentiation of carcinoma and dissected lymphnode (LN) were recorded exactly.positions、ways of attacted LN were analyzed with relative actors and surgical operatiom scope.Result: Transmation ratio were 20%、21%、37.7% when carcinoma sited in fundus、corpus uteri and cervix was invaded. Iliaca externa LN were invaded most commonly in all cases.Most iliaca extdrna and obturatoria LN were attacted when carcinoma sited in fundus、corpus;iliaca externa、communis LN used to be attacted when cervix was invaded.Transmation ratio of iliaca commumis LN was 25% in the former group,and 70.6% the later,Plt;0.01. All iliaca communis LN were invaded in which para-aortic lymph node and cervix uteri were damaged ,only 30% in thoes corpus uteri carcinoma with para-aortic lymph node transmation.There were significant correlations among invasive degree、pathologic types、cytodifferentiation wieh pelvie LN transmation. Conclusion: It tended to be metastasized to node iliaca externa directlyor by cervix when carcinoma in corpus,but to node iliaca communis andinterna mostly when cervix was inv