CAJ | 학술논문

目的探讨早期宫颈癌患者盆腔淋巴结转移的规律,提出宫颈癌盆腔淋巴结三级分站的可行性.方法选取196例行广泛子宫切除和盆腔淋巴清扫术的Ⅰa2～Ⅱa期宫颈癌患者为研究对象,术前在宫颈肿瘤周围黏膜下3、6、9、12点处分别注射99mTc-硫胶体0.5ml,术后将清扫的盆腔淋巴结用闾讲庖墙刑逋馓讲?确定放射活性计数比同侧淋巴结升高5倍者为前哨淋巴结,将切除的盆腔淋巴结连续切片行HE染色进行病理检测.结果共检出41例患者的83枚转移盆腔淋巴结,其中宫旁和闭孔淋巴结转移65枚,髂内外淋巴结转移17枚,髂总淋巴结转移1枚.22例宫旁淋巴结转移患者中,同时伴有髂内淋巴结转移者3例,髂外淋巴结转移者5例,髂内和髂外淋巴结均转移者1例.19例闭孔淋巴结转移患者中,同时伴有髂内淋巴结转移者3例,髂外淋巴结转移者4例.x2检验显示,宫旁和(或)闭孔淋巴结转移与盆腔其他区域淋巴结的转移呈正相关.共检出转移前哨淋巴结81枚,其中宫旁和闭孔前哨淋巴结转移64枚,髂内外前哨淋巴结转移17枚.宫旁和(或)闭孔淋巴结转移组与非转移组比较,患者的1和3年生存率差异无统计学意义,但非转移组患者的5年生存率(93.2%)明显高于转移组(65.1%).结论宫颈癌患者的盆腔淋巴结转移分为三站是可行的,第1站为宫旁和闭孔区域淋巴结,第2站为髂内和髂外淋巴结,第3站为髂总和腹股沟深淋巴结,可根据转移情况合理地制定患者的治疗方案.
목적 탐토조기궁경암환자분강림파결전이적규률,제출궁경암분강림파결삼급분참적가행성.방법 선취196례행엄범자궁절제화분강림파청소술적Ⅰa2～Ⅱa기궁경암환자위연구대상,술전재궁경종류주위점막하3、6、9、12점처분별주사99mTc-류효체0.5ml,술후장청소적분강림파결용려강포장형포산강?학정방사활성계수비동측림파결승고5배자위전초림파결,장절제적분강림파결련속절편행HE염색진행병리검측.결과 공검출41례환자적83매전이분강림파결,기중궁방화폐공림파결전이65매,가내외림파결전이17매,가총림파결전이1매.22례궁방림파결전이환자중,동시반유가내림파결전이자3례,가외림파결전이자5례,가내화가외림파결균전이자1례.19례폐공림파결전이환자중,동시반유가내림파결전이자3례,가외림파결전이자4례.x2검험현시,궁방화(혹)폐공림파결전이여분강기타구역림파결적전이정정상관.공검출전이전초림파결81매,기중궁방화폐공전초림파결전이64매,가내외전초림파결전이17매.궁방화(혹)폐공림파결전이조여비전이조비교,환자적1화3년생존솔차이무통계학의의,단비전이조환자적5년생존솔(93.2%)명현고우전이조(65.1%).결론 궁경암환자적분강림파결전이분위삼참시가행적,제1참위궁방화폐공구역림파결,제2참위가내화가외림파결,제3참위가총화복고구심림파결,가근거전이정황합리지제정환자적치료방안.
Objective To investigate the distribution of metastatic pelvic lymph nodes in the women with early stage cervical carcinoma, and the feasibility of dividing these nodes into three stations in those patients. Methods 99mTc-DX of 2 ml was injected into the cervix to a depth of 5 to 10mm at 3,6,9,12o'clock positions preoperatively in 196 patients with early stage cervical cancer. Pelvic lymphadenectomy and radical hysterectomy were performed in all patients. Pelvic lymph nodes were detected by ?probe. The sentinel lymph nodes (SLN) were determined if the radioactivity reached 5 times higher than that in the ipsilateral nodes. All resected pelvic lymph nodes were examined by histopathology with HE stained serial sections. Results Of the 196 patients, 41 were found to have metastasis in 83 lymph nodes. The metastatic rate was 78.3% (65/83) in the parametrial and obturator lymph nodes, 20.5% (17/83) in the internal and external iliac lymph nodes, 1.2% (1/83) in the commmon iliac lymph nodes. Of the 22 patients with metastatic parametrial lymph nodes, metastatic external iliac lymph nodes were detected in 5 patients, and metastatic internal iliac lymph nodes in 3 patients. Among the 19 patients with metastatic obturator lymph nodes, metastatic external iliac lymph nodes were found in 4 patients, and metastatic internal iliac lymph nodes in 3 cases. It was shown by Chi-sqare test that the metastases in parametrial and/or obturator lymph nodes were positively correlated with lymph node metastases in other pelvic sites. Eighty-one SLN were found to have metastasis. The metastatic rate of parametrial and obturator SLN was 79.0% (64/81) versus 21.0%(17/81) of internal and external iliac SLN. No statistically significant difference in 1- and 3-yr survival was observed between the groups with and without metastasis in parametrial and obturator lymph nodes, while the5-yr survival rate in the patients without metastatic lymph node was 93.2%, significantly higher than that of patients with lymphatic metastasis (65.1%). Conclusion It is feasible for cervical cancer to divide the pelvic lymph nodes into three levels. The level I lymph nodes consist of parametrial and obturator lymph nodes. Internal and external iliac lymph nodes can be considered as level Ⅱ lymph nodes, and the common iliac and inguinal lymph nodes as level Ⅲ nodes. A rational treatment plan can be made according to the distribution of metastatic pelvic lymph nodes.