子宫内膜癌淋巴结转移规律与手术范围的探讨

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1、子宫内膜癌淋巴结转移规律与手术范围的探讨【关键词】子宫摘要：目的：探讨子宫内膜癌淋巴结转移规律及手术范围。方法：对接受全子宫、盆腔淋巴结切除的180例子宫内膜癌患者，准确记录肿瘤所处子宫腔位置、子宫肌层浸润深度、分期、病理类型、细胞学分级、切除淋巴结位置、总数及阳性淋巴结数。分析淋巴结转移规律及手术范围。结果：位于宫底部、宫体部、累及宫颈者子宫内膜癌淋巴结转移率分别是20%、21%、37.7%，均以髂外淋巴结为最常见的转移部位。病灶局限于宫底、宫体部者多为髂外、闭孔淋巴结转移；累及宫颈者以髂外、髂总淋巴结转移为常见。前者髂总淋巴

2、结转移率为25%，后者为70.6%，P＜0.01。所有腹主动脉旁淋巴结阳性和累及宫颈者的髂总淋巴结均为阳性，而病灶限于宫体的腹主动脉旁淋巴结转移者仅有30%髂总淋巴结阳性。肌层浸润程度、病理类型及细胞分化程度与盆腔淋巴结转移密切相关。结论：位于宫体部的肿瘤可直接或由宫颈转移至髂外淋巴结，宫颈受累者最易发生髂总和髂外淋巴结转移。病灶累及宫颈者髂总淋巴结可作为腹主动脉旁淋巴结的前哨淋巴结。Ⅰ期、G1、局限于子宫内膜的癌肿可仅行全子宫切除。关键词：子宫内膜肿瘤；淋巴结转移；手术7StudyonRegularityofLymphNoda

3、lMetastasisandSurgicalOperationScopeonPatientswithEndometrialCancerAbstract:Objective:Tostudythewayofthenodaldistributionandsurgicaloperationinendometrialcarcinoma.Method:180caseswithendometrialcancertreatedbyhysterectomyandpelviclymphadenectomywerereviewedandanalyze

4、d.Position、invasivedegree、staging、pathologictype、cytodifferentiationofcarcinomaanddissectedlymphnode(LN)wererecordedexactly.positions、waysofattactedLNwereanalyzedwithrelativeactorsandsurgicaloperatiomscope.Result:Transmationratiowere20%、21%、37.7%whencarcinomasitedinf

5、undus、corpusuteriandcervixwasinvaded.IliacaexternaLNwereinvadedmostcommonlyinallcases.MostiliacaextdrnaandobturatoriaLNwereattactedwhencarcinomasitedinfundus、corpus;iliacaexterna、communisLNusedtobeattactedwhencervixwasinvaded.TransmationratioofiliacacommumisLNwas25%i

6、ntheformergroup,and70.6%thelater,P<0.01.AlliliacacommunisLNwereinvadedinwhichpara-aorticlymphnodeandcervixuteriweredamaged,only30%inthoescorpusutericarcinomawithpara-aorticlymphnodetransmation.Thereweresignificantcorrelationsamonginvasivedegree、pathologic7types、cy

7、todifferentiationwiehpelvieLNtransmation.Conclusion:Ittendedtobemetastasizedtonodeiliacaexternadirectlyorbycervixwhencarcinomaincorpus,buttonodeiliacacommunisandinternamostlywhencervixwasinvaded.IliacacommunisLNusedtobedamagedearlierthanpara-aorticlymphnodeinpatients

8、withcervixwasinvaded.ThecancerofⅠstage,G1,limitedatendometriumcangohyste-rectomyonly.Keywords：Endometrialneoplasms;Lymphnodemetasta