早期宫颈癌髂外末端淋巴结转移规律和影响因素  

Incidence and influencing factors of distal external iliac lymph node metastasis in early cervical cancer

作　　者：尹月菊 盛修贵[2] 李兴兰[1] 李大鹏[2] 韩晓运[1] 张小玲[2] 张婷婷[2] 

机构地区：[1]济南大学山东省医学科学院医学与生命科学学院,250117 [2]山东省肿瘤医院妇瘤科

出　　处：《中华肿瘤杂志》2014年第6期457-460,共4页Chinese Journal of Oncology

摘　　要：目的探讨早期宫颈癌髂外末端淋巴结转移规律及其影响因素。方法回顾性分析1995年6月至2011年12月山东省肿瘤医院收治的行广泛子宫切除＋盆腔淋巴清扫术的524例早期宫颈癌患者的临床病理资料，ⅠA期27例，ⅠB期191例，ⅡA期306例。结果盆腔淋巴结转移124例，转移率为23．7％。其中闭孔淋巴结转移率为16．2％（85／524），髂内、髂外淋巴结转移率为12．2％（64／524），髂总淋巴结转移率为2．9％（15／524），髂外末端淋巴结转移率为2．1％（11／524），腹主动脉旁淋巴结转移率为1．7％（9／524）。孤立性髂外末端淋巴结转移率为0．2％（1／524）。27例ⅠA期患者中，仅发现1例闭孔淋巴结转移患者，未发现髂外末端淋巴结转移病例。单因素分析显示，淋巴血管间隙浸润和盆腔其他淋巴结转移与早期宫颈癌患者的髂外末端淋巴结转移有关（均P〈0．05）。多因素分析显示，盆腔其他淋巴结转移是早期宫颈癌髂外末端淋巴结转移的独立危险因素。结论早期宫颈癌髂外末端淋巴结转移率低，对TA期或术中快速病理显示无盆腔淋巴结转移的患者，在切除髂外血管淋巴结时，下界至旋髂深静脉水平，可以考虑保留旋髂深静脉水平以下的髂外末端淋巴结。但若术中快速病理明确有盆腔淋巴结转移，应行系统性盆腔淋巴结清扫，也包括切除髂外末端淋巴结。Objective The distal external iliac lymph nodes are located along the external iliac artery between the deep circumflex iliac vein and the inguinal canal. Our study aimed to investigate the incidence of metastasis in distal external iliac lymph nodes and its association with clinicopathological factors in patients with early stage cervical cancer, and to determine the role of distal external iliac lymph nodes dissection in the surgery. Methods Five hundred and twenty-four patients with early stage cervical cancer underwent radical hysterectomy and bilateral pelvic lymphadenectomy in the Shandong Province Cancer Hospital between June 1995 and December 2011, and their clinicopathological features were analyzed retrospectively. Results Of the 524 patients, 124 （23.7%） had pelvic lymph node metastasis. The metastasis rates were 16.2% （85 of 524 patients） in the obturator lymph nodes, 12.2% （64 of 524 patients） in the internal and external iliac lymph nodes, 2.9% （15 of 524 patients） in the common iliac lymph nodes, 2.1% （11 of 524 patients） in the distal external iliac lymph nodes, and 1.7% （9 of 524 patients） in the para-aortic nodes. The incidence of isolated positive distal external iliac lymph nodes was 0.2%. Univariate analysis showed that lymphovascular space invasion, pelvic lymph node metastases （excluding distal external iliac lymph nodes） were significantly associated with distal external iliac lymph node metastasis （P 〈 0.05 ）. Logistic regression analysis showed that pelvic lymph node metastasis （excluding distal external iliac lymph nodes） was the independent risk factor for metastasis to distal external iliac lymph nodes. Conclusions In early stage cervical cancer, distal external iliac lymph node metastasis is rare, especially in cases with stage IA or without pelvic lymph node metastasis. Less extensive pelvic lymphadeneetomy may be considered in these patients in order to reduce operative complications and improve patients＇ quality of life. The deep circumflex

关 键 词：宫颈肿瘤 淋巴结切除术 盆腔 髂外末端淋巴结 转移 

分 类 号：R737.33[医药卫生—肿瘤]