腹主动脉旁淋巴结切除术在子宫内膜癌治疗中的临床意义

目的探讨子宫内膜癌患者腹主动脉旁淋巴结切除范围及其临床意义。方法回顾四川大学华西第二医院709例患者的临床-病理资料,随访217例行腹主动脉旁淋巴结切除患者的生存情况。结果多因素分析发现：淋巴脉管浸润及盆腔淋巴结转移是发生腹主动脉旁淋巴结转移的独立高危因素（P〈0.05）。腹主动脉旁淋巴结取样组,切除至肠系膜下血管水平组以及肾血管水平组术后10月生存率分别为：98.6%,94.3%和100.0%。结论中低分化、淋巴脉管转移、特殊病理类型、以及晚期子宫内膜癌患者建议切除腹主动脉旁淋巴结,其切除范围应至肾血管水平。

The significance of para-aortic lymphadenectomy in the treatment of endometrial carcinoma

Objective To evaluate the extent and significance of para-aortic lymph node dissection in endometrial carcinoma.Methods The clinicopathologic data of 709 patients with endometrial carcinoma were reviewed and the outcomes of 217 patients who had para-aortic lymph nodes removed were followed up.Results Logistic regression analysis showed that perivascular lymphocytic infitration and pelvic lymphnode metastasis were related to para-aortic lymph node metastasis(P<0.05).The 10-months survival rates in para-aortic lymph node sampling group, para-aortic lymphadenectomy to inferior mesenteric artery and to renal vein groups were 96.8%, 94.3% and 100.0%, respectively.Conclusions It’s necessary to perform para-aortic lymphadenectomy when the pathology demonstrate a carcinoma with grade 2/3, perivascular lymphocytic infiltration, non-endometrial carcinoma and advanced stages.Para-aortic lymphadenectomy should be extended up to the level of renal vessel.