早期宫颈浸润癌腹主动脉旁淋巴结切除的临床价值

目的研究早期宫颈浸润癌患者术中常规行腹主动脉旁淋巴结切除术的应用价值。方法选择手术治疗IBI-IIA2期宫颈鳞癌患者240例进行前瞻性研究，随机将患者分两组，A组120例进行宫颈癌根治术同时予以肠系膜下动脉（IMA）以下腹主动脉旁淋巴结切除术；B组为进行宫颈癌根治术中若探查发现腹主动脉旁淋巴结肿大加做IMA以下腹主动脉旁淋巴结切除术。比较两组患者的手术时间、手术出血量、并发症发生率、住院时间，盆腔、髂总、腹主动脉旁淋巴结转移率之间的差异。结果两组患者的基本情况、术中出血量、手术时间、盆腔、髂总淋巴结转移率之间比较差异无统计学意义（P〉0．05），A组住院时间及盆腔感染率高于B组（P〈0．01），A组腹主动脉旁淋巴结转移率显著高于B组（8．3％VS2．5％，P〈0．05）。结论早期宫颈浸润癌患者在手术治疗中常规行腹主动脉旁淋巴结切除，可发现较多的腹主动脉旁淋巴结转移，对术后治疗具有指导意义，且增加手术并发症及延长住院时间。

The clinical value of para-aortic lymphadenectomy in patients with early stage cervical carcinoma

Objective To investigate the clinical value of routine para - aortic lymphadenectomy in patients with stage Ⅰ B1 and Ⅱ A2 cervical cancers treated by surgical intent.Methods 240 patients with stage Ⅰ B1 and Ⅱ A2 squamous cervical cancer were randomly divided into tow groups( group A and B).120 patients (group A) underwent radical hysterectomy with systematic pelvic lymphadenectomy and paraaortic lymphadenectomy.Other 120 patients (group B) underwent radical hysterectomy with systematic pelvic lymphadenectomy,additional para-aortic lymphadenectomy were carried out when para-aortic lymph nodes were identified as suspicious by visualization and palpation.The operation time,amount of surgical bleeding,length of stay,complications,and metastasis rates of pelvic lymph node,metastasis rates of common iliac lymph node and metastasis rates of para-aortic lymph node were analyzed between two groups.Results The clinical characteristics of the patients had no statistically significant difference between the two groups.The length of stay and the complications of group A were significantly higher than group B ( P ＜0.05 ).During the 240 patients,the metastasis rates of pelvic lymph node,common iliac lymph node and para-aortic lymph node were 27.9％,10.8％ and 5.4％.The metastasis rate of para-aortic lymph node in group A was statistically higher than that in group B( 8.3％ vs 2.5％,P ＜0.05),whereas there had no significant difference of the metastasis rates of pelvic lymph node and common iliac lymph node between the two groups.Conclusions Routine para-aortic lymphadenectomy can be helpful to accurately predict the status of the para-aortic lymph node in patients with stage Ⅰ B1 and Ⅱ A2 cervical cancer,but the length of stay and the complications of operation will increase.