早期宫颈癌淋巴结转移特征及临床相关因素分析  

The clinical analysis of lymph node metastasis features and clinical factors in early stage cervix carcinoma

作　　者：王珺[1] 田维杰 丁娅妮 龚芫 张小蕾 高燕[1] 刘祉君 张惠民[1] 李东林[1] Wang Jun;Tian Weijie;Ding Yani;Gong Yuan;Zhang Xiaolei;Gao Yan;Liu Zhijun;Zhang Huimin;Li Donglin(Department of Obstetrics and Gynecology,Guizhou Provincial People?s Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院妇科,贵阳550002

出　　处：《中国医师杂志》2021年第2期189-192,共4页Journal of Chinese Physician

基　　金：贵州省卫生计生委科学技术基金(gzwjkj2018-1-047);贵州省科技计划课题[(2012)3104]。

摘　　要：目的探讨早期宫颈癌盆腔淋巴结转移规律和分布特征及其相关危险因素。方法回顾性分析贵州省人民医院2016年6月至2019年10月收治的508例Ⅰb~Ⅱb期子宫颈癌行广泛性全子宫切除加盆腔淋巴结清扫术患者的临床病理资料。结果Ⅰb期宫颈癌患者278例,Ⅱa期204例,Ⅱb期26例;患者淋巴结转移阳性率为16.7%(85/508),闭孔淋巴结转移最多见(56.6%);双侧淋巴结转移者19例,占22.35%(19/85);发生淋巴结转移104次(双侧同时转移者计算2次),呈跳跃式淋巴结转移占37.5%(39/104);髂总淋巴结转移占18.3%(19/104)。Ⅱa及Ⅱb期患者的转移率(包括宫旁、淋巴结、卵巢和输卵管转移)高于Ⅰb期,odds ratio(OR)分别为2.30和2.48(P<0.05);中分化肿瘤患者转移率明显高于高分化、低分化肿瘤患者(P<0.05)。不同年龄、组织学类型患者的盆腔淋巴结转移阳性率比较差异无统计学意义(P>0.05);Ⅱa及Ⅱb期患者的盆腔淋巴结转移阳性率明显高于Ⅰb期(P<0.05),中分化肿瘤患者盆腔淋巴结转移阳性率明显高于高分化、低分化肿瘤患者(P<0.05)。结论闭孔淋巴结转移在宫颈癌中最多见,Ⅱa期或中分化肿瘤患者淋巴结转移的风险增加,跳跃式转移也是常见转移方式,这提示术中规范、完整的淋巴结切除术是保证疗效的重要措施。Objective To explore the distribution of pelvic lymph node(PLN)metastasis and the correlative dangerous factors in early cervical cancer patients.Methods The medical records of 508 patients who underwent extensive hysterectomy and lymphadenectomy for International Federation of Gynecology and Obstetrics(FIGO)stageⅠb-Ⅱb cervical cancer in Guizhou Provincial Peopled Hospital were reviewed retrospectively.Results There were 278 patients with stageⅠb cervical cancer,204 patients with stageⅡa cervical cancer and 26 patients with stageⅡb cervical cancer;the positive rate of lymph node metastasis was 16.7%(85/508),and obturator lymph node metastasis was the most common(56.6%);there were 19 patients with bilateral lymph node metastasis,accounting for 22.35%(19/85);lymph node metastasis occurred 104 times(two times for bilateral simultaneous transfer),and jumping lymph node metastasis accounted for 37.5%(39/104);common iliac lymph node metastasis accounted for 18.3%(19/104).The metastasis rate of patients with stageⅡa andⅡb(including parametrial,lymph node,ovarian and oviduct metastasis)was higher than that of patients with stageⅠb,and the odd ratio(OR)was 2.30 and 2.48 respectively(P<0.05);the metastasis rate of patients with moderately differentiated tumors was significantly higher than that of patients with well differentiated and poorly differentiated tumors(P<0.05).There was no significant difference in the positive rate of pelvic lymph node metastasis among patients with different ages and histological types(P>0.05);the positive rate of pelvic lymph node metastasis in patients with stageⅡa andⅡb was higher than that in patients with stageⅠb with statistically significant difference(P<0.05);the positive rate of pelvic lymph node metastasis in patients with moderately differentiated tumors was higher than that in patients with well differentiated and poorly differentiated tumors,with statistically significant difference(P<0.05).Conclusions Obturator lymph node metastasis is the most common in cer

关 键 词：宫颈肿瘤 子宫切除术 淋巴转移 

分 类 号：R737.33[医药卫生—肿瘤]