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目的调查分析ⅠA2~ⅡA2期宫颈癌主韧带浸润情况,探寻影响早期宫颈癌主韧带浸润的高危临床病理因素。方法调取5家医院2004年1月1日至2014年12月31日宫颈癌行手术治疗患者2 982例的临床、病理资料进行回顾性研究。结果 (1)纳入符合研究条件的患者855例,主韧带浸润20例(2.3%)。ⅠA2期无主韧带浸润发生,ⅠB1期主韧带浸润率1.7%、ⅠB2期1.2%、ⅡA1期5.7%、ⅡA2期2.9%,随宫颈癌国际妇产科联盟(FIGO)分期增加,主韧带浸润率无明显增加(P=0.269)。(2)ⅠA2~ⅡA2期宫颈癌左、右侧主韧带浸润率相比较差异无统计学意义(P=1.000);FIGO分期不同的左侧主韧带浸润率差异无统计学意义(P=0.286),而右侧主韧带浸润率则差异有统计学意义(P=0.005),其中ⅡA1期最高(4.3%)。(3)单因素分析发现淋巴脉管浸润、宫颈间质浸润深度、盆腔淋巴结转移、宫体浸润、阴道穹窿浸润是主韧带浸润的危险因素(P<0.1);多因素分析确定宫体浸润(OR=11.858)、盆腔淋巴结转移(OR=6.359)及阴道穹窿浸润(OR=6.012)为主韧带浸润的危险因素(P<0.05)。结论早期宫颈癌主韧带浸润的发生率低,宫体浸润、盆腔淋巴结转移、阴道穹窿浸润是影响ⅠA2~ⅡA2期宫颈癌主韧带浸润的危险因素。
Objective To investigate the infiltration of primary ligament in patients with stage ⅠA2 ~ ⅡA2 cervical cancer and explore the high risk clinical and pathological factors that affect the invasion of primary ligament in early stage of cervical cancer. Methods The clinical and pathological data of 2 982 patients undergoing surgical treatment of cervical cancer from January 1, 2004 to December 31, 2014 in five hospitals were retrospectively studied. Results (1) A total of 855 patients were enrolled in the study, 20 cases (2.3%) were infiltrated with the main ligament. The main infiltration rate of primary ligament occurred in stage ⅠA2. The main infiltration rate of primary ligament in stage ⅠB1 was 1.7%, in stage ⅠB2 1.2%, in stage ⅡA1 5.7% and in stage ⅡA2 2.9%. With the increase of FIGO stage, No significant increase (P = 0.269). (2) There was no significant difference in the infiltration rate of the left and right main ligaments between ⅠA2 ~ ⅡA2 cervical cancer (P = 1.000). There was no significant difference in the infiltration rate of the left main ligament between the FIGO stages (P = 0.286) , While the infiltration rate of the right main ligament was statistically different (P = 0.005), of which the highest stage Ⅱ A1 (4.3%). (3) Univariate analysis showed that the infiltration of lymph vessels, the depth of cervical interstitial infiltration, pelvic lymph node metastasis, uterine infiltration and vaginal vault were the risk factors for the infiltration of the main ligament (P <0.1) OR = 11.858), pelvic lymph node metastasis (OR = 6.359) and vaginal vault invasion (OR = 6.012) were the risk factors for the infiltration of the ligament (P <0.05). Conclusion The incidence of primary ligament infiltration of early stage cervical cancer is low. Infiltration of the uterus, pelvic lymph node metastasis and vaginal vault are the risk factors for the invasion of primary ligament in patients with stage ⅠA2 ~ ⅡA2 cervical cancer.