宫颈癌ⅠA～ⅡB期的盆腔淋巴结转移相关因素分析  

Analysis of the related factors of pelvic lymph node metastasis in patients with ⅠA-ⅡB cervical carcinoma

作　　者：段律芳[1] 李瑞珍[1] 胡艳[1] 

机构地区：[1]北京大学深圳医院,广东深圳518036

出　　处：《右江医学》2013年第4期510-512,共3页Chinese Youjiang Medical Journal

摘　　要：目的观察宫颈癌盆腔淋巴结的分布及影响其转移的因素。方法回顾性分析149例行广泛性子宫切除及盆腔淋巴结清扫的ⅠA～ⅡB期宫颈癌患者临床资料。分析宫颈癌盆腔淋巴结转移的分布情况及宫颈癌盆腔淋巴结转移与临床分期、原发病灶大小、宫颈深肌层浸润、治疗前血SCC-Ag水平、患者年龄、病程、人乳头瘤病毒(HPV)、病理分化、组织学类型、生长方式、阴道穹隆受累等的相关性。结果单因素χ2分析显示:宫颈癌盆腔淋巴结转移与临床分期、原发病灶大小、宫颈深肌层浸润、治疗前血SCC-Ag水平有关(P<0.05或0.01),而与患者年龄、病程、HPV、病理分化、组织学类型、生长方式、阴道穹隆受累等无关(P>0.05)。总体盆腔淋巴结转移率为24.16%(36/149),主要分布于闭孔区(85.71%),其他部位淋巴结转移者多合并有闭孔淋巴结转移。结论临床分期、肿瘤体积大小、宫颈深肌层浸润、治疗前血清SCC-Ag≥4μg/L等因素与宫颈癌盆腔淋巴结转移呈正相关。淋巴结转移主要分布在闭孔区,可能是宫颈癌的前哨淋巴结。但以前哨淋巴结(SLN)活检术替代淋巴结清扫术的可行性和安全性,还需要多中心、大样本病例的前瞻性随机对照研究证实。Objective To investigate the distribution and the related factors of pelvic lymph node metastasis in patients with cervical carcinoma of stages I A- Ⅱ B. Methods The clinical data of 149 cases of patients with stage I A- Ⅱ B cervical cancer,who underwent pervasive hysterectomy and lapaparoscopic pelvic lymphyadenectomy, were retrospectively analyzed. Then, the distribution of pelvic lymph node metastases of uterine cervical carcinoma as well as the correlation of pelvic lymph node metastases of uterine cervical carcinoma with clinical stages, primary lesion, deep muscle infiltration of cervix, the SCC-Ag levels before treatment, the ages of patients, the course of disease, human papilloma virus （HPV）, pathological differentiation, histological type, the growth pattern, and the vaginal fornix in- volvement were analyzed. Results The analysis of simple factor X^2 revealed that the pelvic lymph node metastases of uterine cervical carcinoma was related to clinical stages, primary lesion,deep muscle infiltration of cervix,and the SCC- Ag levels before treatment（ P d0.05 or 0.01） ,but it was not relate to the ages of patients,the course of disease,hu- man papilloma virus （HPV）, pathological differentiation, histological type, growth pattern, and vaginal fornix involvement （ P 〉0.05）. The overall pelvic lymph node metastasis rate was 24.16 % （36/149） and the obturator lymph nodes were the most frequently involved,with the rate of 85.71%. Patients with lymph node metastasis in other parts of the body inclined to have obturator lymph node metastasis. Conclusion Clinical stages,tumor volume, deep muscle infil- tration of cervix and the SCC-Ag levels（≥4 μg/L） before treatment are positively correlated with the pelvic lymph node metastases of uterine cervical carcinoma. Lymph node metastasis is distributed mainly over the obturator fora- men area,and obturator lymph nodes may be the sentinel lymph node of cervical cancer. However,if the sentinel lymph node biopsy was used to replace the pelvi

关 键 词：宫颈癌 淋巴结转移 转移规律 高危因素 

分 类 号：R737.33[医药卫生—肿瘤]