早期宫颈癌子宫动脉转移的研究  

Research of Uterine Artery Involvement in Early Cervical Cancer

作　　者：林少丹[1] 周晖[1] 王东雁[1] 饶群仙[1] 彭永排[1] 林荣春[1] 谢玲玲[1] 林仲秋[1] 

机构地区：[1]中山大学孙逸仙纪念医院妇科肿瘤科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2016年第4期568-574,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：卫生部临床学科重点项目(卫规财函[2010]439)

摘　　要：【目的】分析早期宫颈癌子宫动脉受侵犯的情况及其相关因素,探讨保留子宫动脉的宫颈癌手术的安全性。【方法】收集2012年9月至2014年3月在中山大学孙逸仙纪念医院接受手术治疗的61例早期宫颈癌患者的临床病例资料,并取其从髂内动脉起始部至输尿管隧道顶端之间的子宫动脉段,对其受累情况进行研究。所有离体子宫动脉送病理检查。采用SPSS 13.0统计软件对收集的资料进行统计分析。【结果】1例出现子宫动脉转移,子宫动脉转移率为1.6%。3例患者子宫动脉旁淋巴结阳性,子宫动脉旁淋巴结转移率为4.9%。宫旁软组织转移组子宫动脉转移率为50%,高于无转移组1.6%,盆腔其他地方转移组子宫动脉旁淋巴结转移率为100%,高于无转移组(1.7%),差异均有统计学意义(P<0.05)。单因素分析提示:宫旁软组织、盆腔其他地方转移可能与子宫动脉总的转移相关(P均<0.05)。多因素分析,尚未发现其他指标与子宫动脉总的转移之间的相关性。同时存在3个及3个以上的下列因素者:肿瘤>2 cm、脉管受累、浸润宫颈外1/2间质、盆腔淋巴结转移、阴道累及、颈体交界累及、临床分期晚(ⅡB期),子宫动脉或子宫动脉旁淋巴结总的转移风险明显升高(P<0.05)。同时存在的因素个数越多,子宫动脉总的转移风险越高。【结论】1早期宫颈癌中子宫动脉转移的可能性很小,故对没有明显宫旁转移的早期宫颈癌患者可以考虑行保留子宫动脉分支的宫颈癌根治术,对符合行宫颈根治术指征且肿瘤小于2 cm的可以考虑行保留子宫动脉的广泛宫颈切除术。2早期宫颈癌同时存在≥3个以上因素且要求手术治疗者,建议行传统的PiverⅢ型根治性子宫切除术。[Objective] This study aims to analyze uterine artery involvement and its related factors in the early cervical cancer, and to explore the safety of the preservation of uterine artery in radical hysterectomy and radical trachelectomy. [ Methods ] We collected the specimens of uterine artery in patients with early cervical cancer from September 2012 to March 2014, and had pathological examination on them to study the involvement and the related factors. The specimens of uterine arteries we collected were from their origin to the parts before corpus uteri branch and cervix uteri branch. All the uterine artery specimens were observed pathologically. Data was analyzed in SPSS 13.0 software. [Result] A total of 61 patients were included in the study, of which there were 35 patients receiving the traditional procedure and 26 patients receiving the modified procedure. Only 1 case was with uterine artery involvement. The rate of uterine artery involvement was 1.6%. And another 3 cases had positive lymph node next to uterine artery. The rate of metastasis of the lymph node next to uterine artery was 4.9%. The rate of uterine artery was 50% in the group with parametrial tissue involvement, higher than that （1.6%） in the group without parametrial tissue involvement. The rate of involvement of lymph node next to uterine artery in the group with other pelvic metastasis was 100%, higher than that （1.7%） in the group without metastasis. And the differences were statistically significant （P 〈 O.05）.By univariate logistic regression analysis, Parametrial tissue involvement and other pelvic metastasis were significantly associated with the involvement of uterine artery and/or the lymph node next to it （P 〈 0.05）. No relation between the total uterine artery involvement and each character had been found yet by multivariate logistic regression analysis. All the patients with involvement of uterine artery or lymph node next to uterine artery had 3 or more than 3 following characters at the same time： tumor size�

关 键 词：早期宫颈癌 子宫动脉转移 宫旁转移 宫颈癌根治术 

分 类 号：R392.4[医药卫生—免疫学]