早期宫颈癌盆腔淋巴结转移的分布  

The rule of metastatic pelvic lymph node distribution in patients with early stage cervical carcinoma

作　　者：张海燕[1] 盛修贵[1] 钟艳[1] 马志芳[1] 马悦冰[1] 刘乃富[1] 陈月婷[1] 王颖颖[1] 

机构地区：[1]山东省肿瘤医院妇瘤科,济南250017

出　　处：《中华肿瘤杂志》2008年第6期452-455,共4页Chinese Journal of Oncology

摘　　要：目的探讨早期宫颈癌患者盆腔淋巴结转移的规律，提出宫颈癌盆腔淋巴结三级分站的可行性。方法选取196例行广泛子宫切除和盆腔淋巴清扫术的Ⅰa2～Ⅱa期宫颈癌患者为研究对象，术前在宫颈肿瘤周围黏膜下3、6、9、12点处分别注射^99mTc-硫胶体0．5ml，术后将清扫的盆腔淋巴结用1探测仪进行体外探测，确定放射活性计数比同侧淋巴结升高5倍者为前哨淋巴结，将切除的盆腔淋巴结连续切片行HE染色进行病理检测。结果共检出41例患者的83枚转移盆腔淋巴结，其中宫旁和闭孔淋巴结转移65枚，髂内外淋巴结转移17枚，髂总淋巴结转移1枚。22例宫旁淋巴结转移患者中，同时伴有髂内淋巴结转移者3例，髂外淋巴结转移者5例，髂内和髂外淋巴结均转移者1例。19例闭孔淋巴结转移患者中，同时伴有髂内淋巴结转移者3例，髂外淋巴结转移者4例。X^2检验显示，宫旁和（或）闭孔淋巴结转移与盆腔其他区域淋巴结的转移呈正相关。共检出转移前哨淋巴结81枚，其中宫旁和闭孔前哨淋巴结转移64枚，髂内外前哨淋巴结转移17枚。宫旁和（或）闭孔淋巴结转移组与非转移组比较，患者的1和3年生存率差异无统计学意义，但非转移组患者的5年生存率（93．2％）明显高于转移组（65．1％）。结论宫颈癌患者的盆腔淋巴结转移分为三站是可行的，第1站为宫旁和闭孔区域淋巴结，第2站为髂内和髂外淋巴结，第3站为髂总和腹股沟深淋巴结，可根据转移情况合理地制定患者的治疗方案。Objective To investigate the distribution of metastatic pelvic lymph nodes in the women with early stage cervical carcinoma, and the feasibility of dividing these nodes into three stations in those patients. Methods ^99mTc-DX of 2 ml was injected into the cervix to a depth of 5 to 10 mm at 3,6,9,12 o＇clock positions preoperatively in 196 patients with early stage cervical cancer. Pelvic lymphadenectomy and radical hysterectomy were performed in all patients. Pelvic lymph nodes were detected by γ-probe. The sentinel lymph nodes （SLN） were determined if the radioactivity reached 5 times higher than that in the ipsilateral nodes. All resected pelvic lymph nodes were examined by histopathology with HE stained serial sections. Results Of the 196 patients, 41 were found to have metastasis in 83 lymph nodes. The metastatic rate was 78.3% （65/83）in the parametrial and obturator lymph nodes, 20.5% （17/83）in the internal and external iliac lymph nodes, 1.2% （1/83）in the commmon iliac lymph nodes. Of the 22 patients with metastatic parametrial lymph nodes, metastatic external iliac lymph nodes were detected in 5 patients, and metastatic internal iliac lymph nodes in 3 patients. Among the 19 patients with metastatic obturator lymph nodes, metastatic external iliac lymph nodes were found in 4 patients, and metastatic internal iliac lymph nodes in 3 cases. It was shown by Chi-sqare test that the metastases in parametrial and/or obturator lymph nodes were positively correlated with lymph node metastases in other pelvic sites. Eighty-one SLN were found to have metastasis. The metastatic rate of parametrial and obturator SLN was 79.0% （64/81） versus 21.0% （ 17/81 ） of internal and external iliac SLN. No statistically significant difference in 1- and 3-yr survival was observed between the groups with and without metastasis in parametrial and obturator lymph nodes, while the 5-yr survival rate in the patients without metastatic lymph node was 93.2%, significantly higher than that of patients with lymphati

关 键 词：宫颈肿瘤 盆腔淋巴结 前哨淋巴结 转移 

分 类 号：R686[医药卫生—骨科学]