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目的探讨影响ⅠA~ⅡB期宫颈鳞癌盆腔淋巴结转移的临床病理高危因素。方法对2004年11月—2013年7月北京大学人民医院接受手术治疗的ⅠA~ⅡB期宫颈鳞癌296例患者的临床病理资料进行回顾性分析,探讨盆腔淋巴结转移的相关高危因素。结果 296例宫颈鳞癌患者中,ⅠA期33例,ⅠB期143例,ⅡA期61例,ⅡB期59例;平均每例切除淋巴结27个,盆腔淋巴结转移率为20.27%(60/296),其中19例因分别行左、右侧淋巴结整片切除,未能区分淋巴结部位,其余41例淋巴结转移中,闭孔淋巴结最多受累(58.54%,24/41),其次分别是髂外淋巴结(51.22%,21/41)、髂内淋巴结(31.15%,14/41)、髂总淋巴结(26.83%,11/41)和腹股沟深淋巴结(9.76%,4/41)。单因素分析显示,临床分期、病理分级、肿瘤直径、淋巴脉管间质浸润(LVSI)、宫颈间质浸润深度、子宫浸润及宫旁浸润与宫颈癌盆腔淋巴结转移密切相关(P<0.05);多因素分析显示,脉管内癌栓(P=0.000)、宫颈间质浸润深度(P=0.003)及宫旁浸润(P=0.029)是影响ⅠA~ⅡB期宫颈鳞癌盆腔淋巴结转移的显著独立危险因素。结论在ⅠA~ⅡB期宫颈鳞癌中,最易受累的淋巴结是闭孔淋巴结,其次是髂外淋巴结。LVSI、宫旁浸润及宫颈间质浸润深度是ⅠA~ⅡB期宫颈鳞癌盆腔淋巴结转移的显著独立危险因素。
Objective To investigate the clinicopathological and pathological factors that affect the metastasis of pelvic lymph nodes in patients with stage ⅠA ~ ⅡB cervical squamous cell carcinoma. Methods The clinical and pathological data of 296 patients with stage ⅠA ~ ⅡB cervical squamous cell carcinoma who underwent surgery from Peking University People’s Hospital from November 2004 to July 2013 were analyzed retrospectively to investigate the risk factors associated with pelvic lymph node metastasis. Results Among 296 patients with cervical squamous cell carcinoma, there were 33 cases of stage IA, 143 cases of stage IB, 61 cases of stage IIA and 59 cases of stage IIB. There were 27 resected lymph nodes and 20.27% (60/296) pelvic lymphadenectasis on average. Of the 41 cases, the closed lymph nodes were the most involved (58.54%, 24/41) in the remaining 41 cases, followed by the external iliac lymph nodes (51.22%) (21.15%, 14/41), common iliac lymph nodes (26.83%, 11/41) and deep inguinal lymph nodes (9.76%, 4/41) respectively. Univariate analysis showed that clinical stage, pathological grade, tumor diameter, lymphatic vessel interstitial infiltration (LVSI), depth of cervical interstitial infiltration, uterine infiltration and uterine infiltration were closely related to pelvic lymph node metastasis (P <0.05). Multivariate analysis showed that intratracheal intubation (P = 0.000), depth of cervical interstitial invasion (P = 0.003) and parametrial invasion (P = 0.029) were significant independent risk factors for metastases of cervical squamous cell carcinoma of stage ⅠA ~ ⅡB factor. Conclusions In ⅠA ~ ⅡB cervical squamous cell carcinoma, the lymph nodes most likely to be involved are obturator lymph nodes, followed by the external iliac lymph nodes. LVSI, parametrial infiltration and depth of cervical interstitial infiltration were significant independent risk factors for pelvic lymph node metastasis in stage ⅠA-ⅡB cervical squamous cell carcinoma.