CAJ | 학술논문

目的：采用在体子宫动脉血管网数字化三维重建方法，探讨早期宫颈癌灶血供均衡性与术后病理学指标之间的相关性。方法收集术前行盆腔CTA扫描的FIGO分期Ⅰb1期、Ⅱa1期宫颈癌手术患者87例。将CTA数据集导入Mimics软件行子宫动脉血管网数字化三维重建，并立体分割计算双侧宫颈癌灶血管网体积。根据宫颈癌灶血供一侧占双侧的比例分为均衡型（40％～60％）和非均衡型（＜40％或＞60％）2种血供类型。分析2种血供类型与术后病理学指标包括病理学类型、肿瘤最大径、组织分化程度、宫颈浸润深度、脉管间隙浸润、宫旁浸润、宫体浸润、阴道浸润、盆腔淋巴结转移的相关性。结果87例患者中宫颈癌灶血供均衡型29例，非均衡型58例。有阴道浸润的血供均衡型比例更高（ P＝0.003）。其他病理学指标与血供均衡性无相关性（ P＞0.05）。结论早期宫颈癌灶以血供非均衡型为主，呈偏向性生长；阴道浸润可增强对侧子宫动脉对宫颈癌灶供血。
목적：채용재체자궁동맥혈관망수자화삼유중건방법，탐토조기궁경암조혈공균형성여술후병이학지표지간적상관성。방법수집술전행분강CTA소묘적FIGO분기Ⅰb1기、Ⅱa1기궁경암수술환자87례。장CTA수거집도입Mimics연건행자궁동맥혈관망수자화삼유중건，병입체분할계산쌍측궁경암조혈관망체적。근거궁경암조혈공일측점쌍측적비례분위균형형（40％～60％）화비균형형（＜40％혹＞60％）2충혈공류형。분석2충혈공류형여술후병이학지표포괄병이학류형、종류최대경、조직분화정도、궁경침윤심도、맥관간극침윤、궁방침윤、궁체침윤、음도침윤、분강림파결전이적상관성。결과87례환자중궁경암조혈공균형형29례，비균형형58례。유음도침윤적혈공균형형비례경고（ P＝0.003）。기타병이학지표여혈공균형성무상관성（ P＞0.05）。결론조기궁경암조이혈공비균형형위주，정편향성생장；음도침윤가증강대측자궁동맥대궁경암조공혈。
Objective To investigate the correlation between the type of tumor blood supply balance and postop -erative pathological factors in early stage cervical cancer through in vivo three-dimensional reconstruction of the uterine artery network.Methods A total of 87 cases of FIGO stages Ⅰb1 andⅡa1 cervical cancer, with preoperative scan of computed tomography angiography ( CTA) , were enrolled in the study .The uterine artery network model of each case was reconstructed from the preoperative CTA data using the software Mimics .Space partitioning was performed before calcula-tion of the volume of tumor arterial network on either side of the lesion .A definition was made for the types of tumor blood supply balance:balanced type , in which the ratio of the volume of arteries of one side to that of both sides of the cervical cancer was between 40%and 60%;unbalanced , in which the ratio of the volume of arteries of one side to that of both sides was less than 40%or higher than 60%.The correlation between the type of blood supply and various postoperative pathological indices , including pathological type , maximal tumor diameter , degree of differentiation , depth of invasion in cervix, lymph-vascular space invasion , parametrial infiltration, endometrial invasion , vaginal invasion and pelvic lymph node metastasis were analyzed .Results Out of the 87 cases enrolled, 29 were of the balanced type and 58 were of the un-balanced type .Cases with vaginal invasion had higher proportion of balanced type ( P=0.003 ) .No statistically signifi-cant difference was found between the blood supply balance type and other pathological indices (P>0.05).Conclusions The majority of early stage cervical cancer cases are of the unbalanced type , which suggests that tumor growth deflects towards one side of the cervix .Vaginal invasion enhances blood supply to the cancer lesion from the contralateral uterine artery.