骶前淋巴结清扫术在子宫内膜癌治疗中的价值

目的 探讨影响子宫内膜癌患者骶前淋巴结转移的因素及骶前淋巴结清扫术在子宫内膜癌治疗中的价值.方法选取滨州医学院烟台附属医院2005年1月至2015年12月行手术治疗的子宫内膜癌初治患者200例,收集所有患者的临床资料及病理信息.87例行骶前淋巴结清扫术患者为实验组,分析影响骶前淋巴结转移的因素;同期未行骶前淋巴清扫术的113例患者为对照组,采用Kaplan-Meier法比较两组患者的总生存期.结果87例行骶前淋巴结清扫的患者中,有14例(16%)发生骶前淋巴结转移,其中年龄≥45岁、低分化、肌层浸润深度>1/2、宫颈受累、附件受累、盆腔冲洗细胞阳性患者,骶前淋巴结转移发生率较高(OR值分别为6.293、5.562、5.150、8.548、8.258、11.774,均P<0.05),病理类型与骶前淋巴结转移无关(P=0.733).实验组和对照组平均生存时间分别为45个月和31个月,差异有统计学意义(χ2=6.346,P<0.05).结论在子宫内膜癌中,年龄较大、病理分级越高、肌层浸润越深,以及宫颈、附件受累,盆腔冲洗细胞阳性均为骶前淋巴结转移的高危因素,行骶前淋巴结清扫术能够显著延长患者生存时间.

Value of presacral lymph node dissection in treatment of endometrial carcinoma

Objective To investigate the influential factors of presacral lymph node metastasis in endometrial cancer patients and the value of presacral lymph node dissection in endometrial carcinoma treatment .Methods Two hundred patients receiving primary treatment of endometrial carcinoma in Affiliated Yantai Hospital of Binzhou Medical University from January to December 2015 were selected , and clinical data and pathological information of them were collected .Eighty-seven cases treated with presacral lymph node dissection were assigned in experimental group .Influential factors of presacral lymph node metastasis were analyzed .Meanwhile , 113 patients not receiving presacral lymph node dissection were chosen in control group .Overall survival of patients in two groups was compared using Kaplan-Meier method.Results Among 87 patients who accepted presacral lymph node dissection , 14 patients (16%) were detected with presacral lymph node metastasis.Patients over 45 years old, with poorly differentiated carcinoma , myometrial invasion depth more than 1/2, cervical involvement , adnexal involvement , and positive pelvic exfoliative cell had higher incidence of presacral lymph node metastasis ( OR value was 6.293, 5.562, 5.150, 8.548, 8.258 and 11.774, respectively, all P<0.05).Pathologic type was not associated with presacral lymph node metastasis (P=0.733).Average survival in the experimental group and the control group was 45 months and 31 months, respectively, and the difference was statistically significant (χ2 =6.346, P<0.05).Conclusion Advanced age, high pathological grade , deep myometrial invasion , cervical and adnexal involvement and positive pelvic exfoliative cells are risk factors of presacral lymph node metastasis , and presacral lymph node dissection can significantly prolong survival of endometrial cancer patients .