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目的:探讨上皮性卵巢癌患者行腹主动脉旁淋巴结清除术与其生存预后的关系。方法:回顾分析卵巢癌肿瘤细胞减灭术的80例患者,将其中行腹主动脉旁淋巴结(PAN)+盆腔淋巴结(PLN)清除术分为A组(30例),仅行PLN清除术者分为B组(50例),分析PAN清除与患者生存预后的相关性。结果:行卵巢肿瘤细胞减灭术的80例患者中,32例(40.0%)发生淋巴结转移。A组中19例发生淋巴结转移,其中仅PAN阳性7例,仅PLN阳性3例,PAN和PLN均阳性9例;B组中13例发生PLN转移。A与B组患者的淋巴结转移与临床分期、肿瘤细胞分化程度和组织学类型显著相关(P<0.05)。A组中淋巴结转移部位以PAN最多16例,其余依次为髂内、闭孔、髂总、腹股沟及髂外淋巴结。A组患者的3年、5年生存率分别为77.9%和46.7%,均高于B组(69.0%和39.2%),但无显著差异(P>0.05)。A与B组患者中转移至PLN者的3年生存率分别是68.5%和41.4%,5年生存率是49.7%和26.4%,两组比较差异显著(P=0.044)。A组患者中淋巴结阳性与阴性患者3年生存率分别为43.5%和72.7%,5年生存率是27.2%和58.5%,差异显著(P=0.048)。Cox模型单因素分析提示,淋巴结状态对患者的生存率有影响(P<0.01),而且是死亡风险因素。结论:腹主动脉旁淋巴结的清除对改善卵巢癌患者预后起着重要作用。
Objective: To investigate the relationship between para-aortic lymph node dissection and its prognosis in patients with epithelial ovarian cancer. Methods: Eighty patients with ovarian cancer cytoreductive surgery were retrospectively analyzed. Patients undergoing aortic dissection and pelvic lymph node dissection (PLN) were divided into group A (n = 30) and PLN only Divided into group B (50 cases), analysis of PAN clearance and prognosis of patients with the correlation. Results: Of the 80 patients who underwent ovarian tumor cytoreductive surgery, 32 (40.0%) had lymph node metastases. In group A, 19 cases had lymph node metastasis, of which 7 cases were PAN positive, only 3 cases were positive for PLN, 9 cases were positive for PAN and PLN, and 13 cases were PLN metastasis in group B. The lymph node metastasis in group A and B was significantly correlated with clinical stage, tumor cell differentiation and histological type (P <0.05). A group of lymph node metastasis to PAN up to 16 cases, followed by the other iliac, obturator, common iliac, inguinal and external iliac lymph nodes. The 3-year and 5-year survival rates of patients in group A were 77.9% and 46.7%, respectively, which were significantly higher than those in group B (69.0% and 39.2%, respectively) (P> 0.05). The 3-year survival rates of patients in groups A and B who were transferred to PLN were 68.5% and 41.4%, respectively. The 5-year survival rates were 49.7% and 26.4%, respectively. There was significant difference between the two groups (P = 0.044). The 3-year survival rates of patients with positive and negative lymph nodes in group A were 43.5% and 72.7%, respectively. The 5-year survival rates were 27.2% and 58.5%, respectively, with significant differences (P = 0.048). Cox model univariate analysis suggested that lymph node status had an impact on the survival rate of patients (P <0.01), but also a risk factor for death. Conclusion: The removal of para-aortic lymph nodes plays an important role in the prognosis of patients with ovarian cancer.