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目的了解子宫颈癌盆腔淋巴结转移的规律,为选择性盆腔淋巴结清扫术提供依据。方法对1990年1月至2004年12月北京大学第一医院妇产科收治的143例宫颈癌患者行广泛性子宫切除及盆腔淋巴结清扫术。盆腔淋巴结清扫依次剔除双侧髂总、髂外、腹股沟深、髂内及闭孔5组淋巴结,根据病理结果明确转移淋巴结的分布,分析临床病理因素与盆腔淋巴结转移的关系。结果盆腔淋巴结转移35例,占24.5%。其中闭孔淋巴结转移29例,占82.9%,转移率为20.3%(29/143)。35例中仅有1组淋巴结转移的22例(62.9%),其中18例为闭孔淋巴结转移。闭孔淋巴结阴性而其他淋巴结阳性者仅6例(17.1%)。髂淋巴结转移12例,占34.3%,转移率为8.4%(12/143)。闭孔淋巴结转移率高于其他组之和(P<0.01)。右侧淋巴结转移率为20.3%(29/143),高于左侧的11.2%(16/143),P<0.05。ⅡB期、肿瘤浸润宫颈间质深度>1/2、肿瘤病灶>4cm者淋巴结转移率高,而患者年龄、肿瘤病理分级及组织类型与盆腔淋巴结转移无关。结论闭孔淋巴结是宫颈癌最早和最常见的转移部位,其次是髂淋巴结。是否可以仅对有盆腔淋巴结转移高危因素患者进行盆腔淋巴结清扫或仅对闭孔及髂淋巴结进行选择性切除值得进一步探讨。
Objective To understand the rule of pelvic lymph node metastasis in cervical cancer and provide basis for selective pelvic lymph node dissection. Methods A total of 143 cases of cervical cancer admitted to Department of Obstetrics and Gynecology, Peking University First Hospital from January 1990 to December 2004 underwent extensive hysterectomy and pelvic lymphadenectomy. Pelvic lymph node dissection followed by removal of bilateral common iliac, external iliac, deep inguinal, internal iliac and obturator lymph nodes. The distribution of lymph nodes was determined according to the pathological results. The relationship between clinicopathological features and pelvic lymph node metastasis was analyzed. Results Pelvic lymph node metastasis in 35 cases, accounting for 24.5%. Among them, there were 29 cases of closed-cell lymph node metastasis, accounting for 82.9%. The metastasis rate was 20.3% (29/143). Twenty-two of the 35 patients (62.9%) had only one lymph node metastasis, of which 18 were closed-cell lymph node metastases. Obturator lymph nodes were negative and other lymph nodes were positive in only 6 cases (17.1%). Twelve cases of iliac lymph node metastasis (34.3%) had metastasis rate of 8.4% (12/143). Obstructive lymph node metastasis rate was higher than other groups (P <0.01). Right lymph node metastasis rate was 20.3% (29/143), higher than the left 11.2% (16/143), P <0.05. Stage ⅡB, tumor infiltration of cervical stromal depth> 1/2, tumor lesions> 4cm lymph node metastasis rate, and age, tumor pathological grade and tissue type has nothing to do with pelvic lymph node metastasis. Conclusion Closed-cell lymph nodes are the earliest and most common metastatic sites of cervical cancer, followed by iliac lymph nodes. Whether pelvic lymph node dissection or only selective resection of obturator and iliac lymph nodes in patients with high risk of pelvic lymph node metastases is worth further exploration.