子宫颈癌不作淋巴结切除的主动脉旁淋巴结照射

宫颈癌主动脉旁淋巴结转移的照射问题尚有争论。作者从1975～1984年对29例高危而未作淋巴结切除分期的宫颈癌作主动脉旁淋巴结照射研究,并作为整体放疗中的一部分。22例作淋巴造影,凡淋巴结有充盈缺损、完全破坏或淋巴管梗阻者为异常,否则为正常。25例未行手术,4例作开腹探查。20例因淋巴造影异常,另9例因肿瘤巨大且分化程度为中度或差而照射主动脉旁。这些病例均预计至少有主动脉旁淋巴结微小转移。照射方法:用10MV光子线,25例以前后、后前野,3例用4野,1例用旋转技术照射主动脉旁淋巴结,野上界延伸至T_(11～12)间隙(10例)、或T_(12)～L_1间隙(19例)。21例同时包括主动脉旁与盆部,8例则分开照射。主动脉旁野每次1.5～1.8Gy,总量42～50Gy,宫颈(A点)与盆部淋巴结     

前哨淋巴结与宫颈癌

前哨淋巴结是原发肿瘤区域淋巴引流的第一站,是最早发生肿瘤转移的部位。前哨淋巴结定位有染料法、核素法、联合法3种方法,对前哨淋巴结进行病理连续切片和免疫组织化学染色提高了微小转移灶的检出率,进而能有效判断淋巴结的转移情况。前哨淋巴结在宫颈癌的应用尚处在起步阶段。     

子宫颈癌的淋巴结转移

子宫颈癌的研究已有200余年的历史,在早期诊断及治疗上都取得了较大的成就。宫颈癌的治疗已有系统的方案,疗效比较稳定,但是,想要提高治愈率,还存在一些问题,主要是防止复发及转移。早期患者如果首次治疗恰当,中心复发可大为减少,如果首次治疗未能达到病变的全部范围,往往会出现中心治愈远处转移的现象,淋巴结的转移是发生得最多而最早,因此,最近四十多年来,不少作者致力于这方面的研究工作,现将近况简单介绍于下。一、宫颈癌淋巴结转移之概况一般说来宫颈癌是趋向于局部发展的,但是,早期的患者,少数人可有盆腔淋巴结转移。Savage(1972)总结580例I_2患者,7例(1.2%)有淋巴     

卵巢癌腹股沟淋巴结转移

卵巢癌腹股沟淋巴结转移郎景和（北京协和医院）淋巴结转移是卵巢恶性肿瘤的重要转移播散途径，主要是腹主动脉旁淋巴结及髂淋巴结。腹股沟淋巴结，特别是浅腹股沟淋巴结转移尚属少见，现报告１例并予讨论。１病例摘要患者，５７岁，１９９０年８月３１日行卵巢癌细胞减灭...     

腹腔镜盆腔淋巴结清扫过程中应用阴道导管外置淋巴结

腹腔镜技术用于妇科恶性肿瘤盆腔淋巴结清扫术,包括淋巴结的摘除与外置。按以往方法淋巴结摘除以后经腹部活门口取出,既费时又易将淋巴结拉碎,大块的淋巴组织如果不分成小块也很难移出,将一根导管在子宫切除术后放入阴(?)通过此导管外置淋巴结使以上问题得到解决。 具体方法:导管由坚固而富有弹性且透亮的聚乙烯材料制成,其远端带有一个活门,用氧化乙烯消毒,根据阴道宽度选择不同直径的导管,一般绝经前经产妇女容纳导管的直经是45mm;但老年和未产妇女所需导管直径偏细,约35mm。在子宫切除后将导     

局部晚期子宫内膜癌淋巴结阴性行淋巴结切除术的潜在益处

子宫内膜癌是最常见的妇科肿瘤 ,如果患者能够得以早期诊断和获得正确的治疗 ,治愈率可达 84 %。子宫内膜癌的手术分期可以准确地了解病变范围并确立个体治疗原则。手术分期包括子宫、双附件切除、淋巴结活检和腹腔细胞学检查。 期子宫内膜癌单纯手术治疗其盆腔复发率为 8.8% ,有高危因素者 (低分化 G3或肌层浸润深度 >1/ 3者 ) ,阴道复发率为 15 % ,对这部分患者大多数医疗机构术后多给予全盆体外照射 4 5～ 5 0 Gy。为评价盆腔和主动脉旁淋巴结阴性的 期高危子宫内膜癌患者 ,术后接受近距离后装治疗与全盆体外照射的临床效果 ,并比较其…     

查健康,自我触摸淋巴结

淋巴结是机体的重要免疫器官.我们平时也许有过这样一种体验:当你的手受伤后,又红又肿化脓时,便会觉得同侧的腋窝处疼痛.仔细一摸,可感到皮肤下面有一个或几个如蚕豆大小的"小玩意儿"又硬又痛在作怪,那就是肿大的淋巴结.当细菌从受伤处进入机体时,淋巴细胞会产生淋巴因子和抗体,有效地杀伤细菌."斗争"的结果,淋巴结内的淋巴细胞和组织细胞反应性增生,使淋巴结肿大,称为淋巴结反应性增生.能引起淋巴结反应性增生的还有病毒、某些化学药物、代谢的毒性产物、变性的组织成分及异物等.癌症经淋巴道转移时,也会引起淋巴结肿大.癌细胞侵入淋巴结,先聚集于边缘窦,以后逐渐生长繁殖而累及整个淋巴结,使淋巴结肿大.因此,肿大的淋巴结还是人体的一个报警装置.由此可见淋巴结的重要性了.     

宫颈癌前哨淋巴结的研究进展

宫颈癌发病率居女性生殖器恶性肿瘤的首位，淋巴转移是其最重要的转移方式，前哨淋巴结是发生淋巴转移的第一站。通过对前哨淋巴结多种方法的识别及免疫功能的研究，进而判断淋巴转移情况，为早期宫颈癌的治疗、预后提供一定的应用价值。     

主动脉旁淋巴结活检法

一般子宫颈癌和体癌的进展期分类多采用国际临床分期分类法(FIGO),并据此决定治疗方针。但 FIGO 分类所反应的癌扩散程度实际上并不完全正确。Nelson(1970)等报告13例Ⅱ_b期至Ⅲ期宫颈癌中7例在治疗前已发现主动脉旁淋巴结(PAN)转移。这很重要,因如有 PAN     

ⅠB～ⅡB期宫颈癌盆腔淋巴结转移的影响因素分析

目的：探讨ⅠB～ⅡB期宫颈癌盆腔淋巴结转移的影响因素。方法：回顾性分析630例行手术治疗的ⅠB～ⅡB期宫颈癌患者的临床资料,了解盆腔淋巴结的转移情况,采用χ2检验、Mann-Whitney U检验和多因素Logistic回归对宫颈癌盆腔淋巴结转移影响因素进行分析。结果：总体盆腔淋巴结转移率为27.9%（176/630）,转移淋巴结754枚,其中74.8%（564/754）分布于宫旁/闭孔区。单因素分析表明,临床分期、细胞分化、宫体受累、脉管间隙受累、宫颈间质浸润深度、鳞状细胞癌抗原（SCC-Ag）和癌抗原125（CA125）水平与盆腔淋巴结转移相关（均P＜0.05）。多因素分析表明,低细胞分化（OR=3.874,95%CI：1.100～13.646,P=0.035）、深1/3宫颈间质浸润（OR=2.735,95%CI：1.675～4.466,P＜0.001）和脉管间隙受累（OR=73.822,95%CI：22.304～244.336,P＜0.001）是盆腔淋巴结转移的独立危险因素。结论：宫颈癌盆腔淋巴结转移以宫旁/闭孔区最易受累,低细胞分化、深宫颈间质浸润、脉管间隙受累发生盆腔淋巴结转移风险较高,在临床治疗中,应确保宫旁切除范围,并实施系统性淋巴结清扫。     

Lymph node metastasis in stage I epithelial ovarian cancer

OBJECTIVES: A relatively high incidence of para-aortic and pelvic lymph node metastasis is found in epithelial ovarian cancer. This paper investigates the clinicomorphological features of intra-abdominal stage I epithelial ovarian cancer that may predict the occurrence of lymph node metastasis and the prognosis of patients in whom lymph node metastases are identified. METHODS: From November 1988 to December 1997 we performed systematic para-aortic and pelvic lymphadenectomy as primary surgery in 47 patients with intra-abdominal stage I epithelial ovarian cancer. The incidence of lymph node metastasis in these patients and the clinicomorphological features of the patients with lymph node involvement were examined. RESULTS: Five patients (10.6%) were metastasis positive (IC: four; IA: one), of whom four had serous adenocarcinoma. Serous adenocarcinoma was associated with a significantly higher incidence of metastases than other histological types (P < 0.05). The number of positive lymph nodes was one in four patients and two in one patient, and the metastatic sites ranged from the para-aortic to the suprainguinal lymph nodes. All five metastasis-positive patients were alive and disease free at the time of this report (survival 28-85 months: median 59 months). CONCLUSION: This clinical study suggests that serous adenocarcinoma carries a high risk of lymph node metastasis, requiring systematic lymphadenectomy for accurate staging in intra-abdominal stage I epithelial ovarian cancer.     

早期宫颈癌淋巴结转移高危因素的探讨

目的：统计分析Ⅰa2和Ⅰb1期宫颈癌的临床病理特征,探讨其盆腔淋巴结转移的高危因素。方法：回顾性分析2011年1月—2013年6月期间在天津市中心妇产科医院治疗的117例Ⅰa2、Ⅰb1期宫颈癌患者的临床资料。使用卡方检验及多元Logistic回归方法分析淋巴结转移的高危因素。结果：117例患者中15例（12.8%）发生淋巴结转移,淋巴结未转移者102例（87.2%）。单因素分析结果：肌层浸润深度≥1/2、子宫下段受累、脉管内瘤栓阳性、肿瘤直径＞2 cm、治疗前宫颈鳞状上皮抗原（SCC-Ag）水平为影响Ⅰa2和Ⅰb1期宫颈癌淋巴结转移的因素（均P＜0.05）。多因素分析结果表明,影响淋巴结转移的独立危险因素为治疗前SCC-Ag≥1.5 ng/mL（OR=25.007,95%CI：2.342～250.021,P=0.008）。结论：治疗前SCC-Ag水平是影响Ⅰa2和Ⅰb1期宫颈癌淋巴结转移的高危因素。     

Combined use of magnetic resonance imaging,CA 125 assay,histologic type,and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma

OBJECTIVE: The aim of this study was to predict retroperitoneal lymph node metastasis during the preoperative examination of patients with endometrial carcinoma and to determine whether lymphadenectomy must be performed. STUDY DESIGN: This study was carried out on 214 patients with endometrial carcinoma. Preoperative evaluators were volume index, depth of myometrial invasion (as assessed by magnetic resonance imaging), serum CA 125 level, histologic type, and histologic grade. With the use of receiver operating characteristic curves, cutoff values of volume index and serum CA 125 levels were determined. The relationships of these evaluators with pelvic lymph node metastasis were investigated by multivariate analysis with a logistic regression model. The relationships of these evaluators with para-aortic lymph node metastasis were investigated in the same way. RESULTS: Histologic type, volume index, histologic grade, and serum CA 125 level were found to be independent risk factors for pelvic lymph node metastasis; serum CA 125 level and volume index were found to be independent risk factors for para-aortic lymph node metastasis. Among 110 cases with no risk factors for pelvic lymph node metastasis, pelvic lymph node metastasis was observed in 4 cases (3.6%). On the other hand, only 1 case of 128 cases (0.7%) with no risk factors for para-aortic lymph node metastasis actually had metastasis. CONCLUSION: Careful consideration of the possibility of the elimination of the requirement of retroperitoneal lymphadenectomy is needed in cases with no risk factors for lymph node metastasis. However, our results suggest that para-aortic lymphadenectomy may not be necessary in cases with no risk factors for para-aortic lymph node metastasis.     

术前SCC-Ag对早期宫颈鳞癌盆腔淋巴结转移预测价值研究

目的探索鳞状细胞癌抗原(SCC-Ag)对宫颈鳞癌盆腔淋巴结转移的预测价值。方法回顾性分析2007年1月至2017年1月于南充市中心医院接受初始治疗为根治性手术的603例早期宫颈鳞癌患者。统计学比较其临床病理特征,并采用Logistic回归分析影响盆腔淋巴结转移的危险因素,绘制ROC曲线确定SCCAg预测盆腔淋巴结转移的最佳临界水平。结果603例早期宫颈鳞癌患者中有淋巴结转移组(113例),无淋巴结转移组(490例)。单因素及多因素分析提示宫旁转移(OR=3.561)、脉管浸润(OR=6.846)和SCC-Ag(OR=8.426)是预测宫颈鳞癌淋巴结转移的独立危险因素。SCC-Ag预测宫颈鳞癌淋巴结转移的最佳临界值为1.7 ng/ml。结论术前SCC-Ag>1.7 ng/ml为宫颈鳞癌盆腔淋巴结转移的独立危险因素。     

早期宫颈癌淋巴结转移规律的临床研究

Objective?To study the risk factors and patterns of pelvic lymph node metastasis in early cervical cancer, which provide a basis for selective lymph node dissection and postoperative individualized clinical target volume (CTV) outlining. Methods?The clinical data of 7 472 patients with early-stage (ⅠA1~ⅡA2) cervical cancer who underwent radical cervical cancer surgery admitted to Hunan Cancer Hospital from January 2009 to December 2015 were retrospectively analyzed. Results?The rate of pelvic lymph node metastasis in 7 472 patients was 12.93%, and the rate of closed lymph node metastasis accounted for 66.37%. Closed lymph node metastasis was correlated with lymph node metastasis in other regions of the pelvis (χ2=919.478, P<0.001). Among patients with lymph node metastasis, the metastasis rates of lymph nodes with local, skip, and continuous metastasis were 47.72%, 26.92%, and 25.36%, respectively. The mode of lymph node metastasis in early-stage cervical cancer was highly correlated with the type of pathology, lymph vascular space invasion(LVSI) and depth of cervical muscle infiltration (χ2=13.339, P<0.01; χ2=11.365, P<0.01; χ2=16.616, P<0.001). In addition, χ2 test showed that age, tumor grade, tumor size, clinical stage, pathological type, LVSI, deep myometrial infiltration of the cervix, and intrauterine involvement were independent influencing factors of pelvic lymph node metastasis (P<0.001); logistic regression analysis showed that age, pathological type, LVSI, deep myometrial infiltration of the cervix, intrauterine involvement, and tumor grade were independent factors of pelvic lymph node metastasis (P<0.01). Conclusion?The metastasis pattern and risk factors of early cervical cancer can guide the scope of lymph node dissection and the outline of CTV in postoperative personalized radiotherapy target area.     

子宫内膜癌卵巢转移危险因素的探讨

目的 探讨子宫内膜癌卵巢转移的危险因素及手术中保留卵巢的可行性.方法 回顾性分析1997年1月至2006年12月在江西省妇幼保健院首治为手术治疗的638例子宫内膜癌患者的临床病理资料.结果 36例(5.6%,36/638)患者发生卵巢转移.单因素分析显示,子宫内膜癌卵巢转移的相关因素为病理类型、病理分级、子宫肌层浸润、腹水或腹腔冲洗液细胞学检查阳性、盆腔淋巴结转移、宫旁浸润、腹主动脉旁淋巴结转移、子宫浆膜浸润(P均＜0.05),而年龄、脉管浸润、宫颈浸润与卵巢转移无明显相关性(P均＞0.05).多因素分析显示,子宫内膜癌卵巢转移的独立危险因素按危险强度排列为:盆腔淋巴结转移、腹水或腹腔冲洗液细胞学检查阳性、病理分级.结论 子宫内膜样腺癌、细胞高分化、无盆腔淋巴结转移、无腹主动脉旁淋巴结转移、元肌层浸润、腹水或腹腔冲洗液细胞学检查阴性、年轻的患者可考虑手术中保留卵巢.     

宫颈腺癌48例临床病例分析

目的:分析宫颈腺癌的临床病理特点和预后影响因素,探讨其治疗方案。方法:回顾分析2005年1月至2015年12月天津医科大学总医院妇产科收治的48例宫颈腺癌患者的临床病理和随访资料。结果:48例患者中位年龄48.5岁(33~84岁),中位随访时间41月(3~132月)。FIGO分期:I期28例(58.3%),Ⅱ期13例(27.1%),Ⅲ期4例(8.3%),Ⅳ期3例(6.3%);阴道不规则出血27例(56.3%)。5年总生存率37.5%。淋巴结转移者的5年生存率为0(0/6),显著低于无转移者[55.17%(16/29)],差异有统计学意义(P0.05);保留卵巢患者的5年生存率为71.43%(5/7),显著高于不保留卵巢者[42.86%(12/28)](P0.05)。局部肿瘤大小(P=0.045)、淋巴结转移(P=0.000)、FIGO分期(P=0.000)、宫旁转移(P=0.043)、卵巢转移(P=0.044)均是影响复发的高危因素。多因素显示,淋巴结转移(P=0.000)和局部肿瘤大小(P=0.050)是肿瘤复发的独立危险因素。淋巴结转移与FIGO分期显著相关(P=0.000)。结论:局部肿瘤大小和淋巴结转移是影响宫颈腺癌复发的主要因素;早期宫颈腺癌患者保留卵巢不影响生存率。     

冰冻病理诊断预测子宫内膜癌淋巴转移的临床价值研究

目的:研究影响子宫内膜癌患者淋巴结转移的因素,评价术中冰冻病理预测淋巴结转移的作用。方法:回顾分析1996年7月至2008年1月在上海交通大学医学院附属仁济医院和2008年9月至2011年9月在同济大学附属第一妇婴保健院收治的共389例子宫内膜癌患者的临床资料,195例患者实施了盆腔淋巴结切除,其中43例同时行腹主动脉旁淋巴结切除。分析患者淋巴结转移的临床相关因素,评价冰冻病理结果在预测淋巴结转移中的价值。结果:盆腔淋巴结转移率为12.8%(25/195),腹主动脉旁淋巴结转移率为11.6%(5/43)。深肌层浸润(P<0.001)、宫颈累及(P<0.001)、ER阴性(P=0.001)与盆腔淋巴结转移显著相关。肿瘤细胞级别升高、病理类型(Ⅰ型、Ⅱ型)与盆腔淋巴结转移无显著相关性。低风险子宫内膜癌(排除G3和肌层深度≥1/2)患者的盆腔淋巴转移率为4.5%(3/67)。按冰冻结果制定4种预测模型,G1+限于内膜组,淋巴结阳性率为0;G1+<1/2肌层组,盆腔和腹主淋巴结阳性率均为2.4%;G2+<1/2肌层组,盆腔和腹主淋巴结阳性率分别为4.8%、0;未发现G2+限于内膜的病例。淋巴结切除组的生存率高于未切除组(79.5%vs 75.9%),但无统计学差异(P=0.086)。结论:冰冻病理用于预测淋巴结转移的作用有限,建议对除G1限于内膜的子宫内膜样腺癌患者,其余均应实施全面的分期手术。     

Lymph node metastasis in ovarian cancer: difference between serous and non-serous primary tumors

OBJECTIVE: To investigate the lymph node sites most susceptible to involvement relative to primary tumor histology in ovarian cancer. METHODS: The locations of metastatic lymph nodes were investigated in 208 patients with primary ovarian cancer who underwent systemic lymphadenectomy covering both the pelvic and para-aortic regions. RESULTS: Lymph node metastasis was present in 12.8% (20/156) of patients with stage I (pT1M0), 48.6% (18/37) with stage II (pT2M0), and 60% (9/15) with stage III (pT3M0) disease, thus in 22.6% (47/208) of all study patients. Isolated para-aortic nodal involvement was present in 23.3% (14/60) of patients with serous tumor and 4.1% (6/148) of those with non-serous tumor (P = 0.00002). In an analysis of 35 positive nodes from 25 patients with up to 3 positive nodes, 86.4% (19/22) of metastatic lymph nodes from patients with serous tumor were found in the para-aortic region, with 14 positive nodes located above the inferior mesenteric artery (IMA) and 5 below it, whereas metastasis to para-aortic lymph nodes accounted for 53.8% (7/13) of metastatic lymph nodes from patients with non-serous tumor (P = 0.0334). CONCLUSIONS: The locations of metastatic lymph nodes in ovarian cancer depend upon the histologic type of the primary cancer. In cases of serous tumor, the para-aortic region, particularly above the IMA, is the prime site for the earliest lymph node metastasis. However, the likelihood of pelvic node involvement is almost equal to that of para-aortic node involvement in cases of non-serous tumor.