髂总动脉淋巴结冰冻活检对预测宫颈癌患者腹主动脉旁淋巴结转移的价值  

The value of common iliac artery lymph node frozen biopsy in predicting para-aortic lymph node metastasis in patients with cervical cancer

作　　者：穆彦敏 卢东方 李娟 刘杏巧 Mu Yanmin;Lu Dongfang;Li Juan;Liu Xingqiao(Department of Gynecology,Xingtai Third Hospital,Xingtai Hebei 054000,P.R.China)

机构地区：[1]邢台市第三医院妇科,河北邢台054000

出　　处：《中国计划生育和妇产科》2023年第7期37-41,56,I0004,共7页Chinese Journal of Family Planning & Gynecotokology

基　　金：邢台市重点研发计划项目(项目编号:2022ZC240)。

摘　　要：目的 探讨术中髂总动脉淋巴结冰冻活检对预测IB2-IIA2期宫颈癌患者腹主动脉旁淋巴结(para-aortic lymph node, PALN)转移的价值。方法 选取2015年1月至2017年12月在邢台市第三医院接受宫颈癌根治术的388例IB2-IIA2期患者作为研究对象。观察组(n=200)接受术中髂总动脉淋巴结冰冻活检,并根据活检结果决定是否进行PALN清扫;对照组(n=188)则均行PALN清扫,不接受冰冻活检。比较两组患者的手术结局、生活质量和生存结局。结果 观察组中9例患者(4.5%)活检结果阳性并行PALN清扫,其中5例(55.6%)存在PALN转移。对照组髂总动脉淋巴结转移率、PALN转移率均为5.3%,髂总动脉淋巴结转移预测PALN转移的特异度为97.2%、阴性预测值为97.2%。多因素分析证实,髂总动脉淋巴结转移是PALN转移的独立危险因素(P<0.001)。与对照组相比,观察组手术时间更短,术中出血量、住院费用更低,术后生活质量更优,差异均有统计学意义(P<0.05)。两组患者的生存结局相近,差异无统计学意义(P>0.05)。结论 术中髂总动脉淋巴结冰冻活检结果可以有效预测IB2-IIA2期宫颈癌患者的PALN转移情况;根据活检结果决定PALN的清扫指征可以在不影响预后的同时显著改善患者的手术结局和生活质量。Objective To investigate the value of intra-operative frozen common iliac lymph nodes biopsy in predicting paraaortic lymph node(PALN)metastasis in patients with stage IB2 to IIA2 cervical cancer.Methods A total of 388 patients with IB2 to IIA2 cervical cancer who underwent radical resection of cervical cancer in Xingtai Third Hospital from January 2015 and December 2017 were selected as the study subjects.The observation group(n=200)received intraoperative frozen biopsy of common iliac artery lymph nodes,and whether PALN dissection was performed was determined according to the biopsy results.The control group(n=188)underwent PALN dissection without frozen biopsy.The surgical outcomes,quality of life,and survival outcomes were compared between the groups.Results In the observation group,9 patients(4.5%)had positive biopsy results and underwent PALN dissection,of which 5 patients(55.6%)had PALN metastasis.In the control group,the common iliac artery lymph node metastasis rate and PALN metastasis rate were both 5.3%,the specificity and negative predictive value of common iliac artery lymph node metastasis in predicting PALN metastasis was 97.2%and 97.2%,respectively.Multivariate analysis suggested that the common iliac lymph node metastasis was an independent risk factor for PALN metastasis(P<0.001).Compared with the control group,the operative time of the observation group was shorter,the intraoperative blood loss and hospitalization expenses were lower,and postoperative quality of life was better,and the differences were statistically significant(P<0.05).The survival outcomes of the two groups were similar,and the difference was not statistically significant(P>0.05).ConclusioTnhe intraoperative frozen biopsy of common iliac lymph nodes can effectively predict PALN metastasis in patients with stage IB2 to IA2 cervical cancer.According to the biopsy results,the indication of PALN dissection can significantly improve the surgical outcome and quality of life of patients without affecting the prognosis.

关 键 词：宫颈癌 术中髂总动脉淋巴结冰冻活检 腹主动脉旁淋巴结清扫 近远期结局 

分 类 号：R711.74[医药卫生—妇产科学]