摘要
目的：研究卵巢恶性肿瘤腹膜后淋巴结转移率及危险因素，为开展腹膜后淋巴清除术提供依据。方法：收集并分析１９８７年１１月至１９９４年１月在我院经淋巴清除术治疗的１１７例原发性卵巢恶性肿瘤病例，采用单因素及多因素分析方法，探讨临床及病理因素与淋巴结转移的关系。结果：病理检查证实４４例（３７．６％）有淋巴结转移。盆腔淋巴结转移率（２９．９％）与腹主动脉旁淋巴结转移率（２０．９％）相比较，差异无显著性（Ｐ＞０．０５）。单因素分析结果表明，原发肿瘤累及两侧卵巢、伴有腹水、临床分期较晚、分化较差、残留灶较大和某些组织类型（如未分化和浆液性腺癌）病例的淋巴结转移率显著增高。经多因素分析，残留灶大小、临床分期及分化程度是淋巴结转移最重要的危险因素（Ｐ＜０．０５）。本研究还对淋巴清除术的指征、时机和范围进行探讨。结论：根据淋巴结转移的危险因素，选择高危、早期病例实施淋巴清除术较为合理，而对有残留灶的晚期患者应择期行淋巴清除术，该手术的范围应包括盆腔及腹主动脉旁淋巴结。
Objective:Toinvestigatetheincidenceandthesignificantriskfactorsofretroperi-toneallymphnodemetastasis(LNM)inprimaryovariancancerforconsideringthenecessityofsys-tematiclymphadenectomy.Methods:117casesofretroperitoneallymphadenectomyperformedonprimaryovariancancersinourhospitalfromNovember,1987toJanuary,1994werestudied.There-lationshipbetweenclinicopathologiccharactersandtheincidenceofLNMweredeterminedbyunivari-ateandmultivariateanalysis.Results:in44(37.6%)ofthe117patientsstudied,LNMwascon-firmedpathologicaly.ThechancesofpelvicLNM(29.9%)weresmilartothatofpara-aorticLNM(20.9%)(P>0.05).UnivariateanalysisshowedthatsignificantlyincreasedincidenceofLNMwasclinicalyasociatedwithbilateralinvolvmentoftheovaries,presenceofascites,advancedstages,poortumordiferentiation,ratherlargeresidualtumorsandsomehistopathologicalsubtypessuchasundiferentiatedandserousadenocarcinoma.Thesizeoftheresidualtumor,clinicalstageandgradeofdiferentiationwerethemostimportantriskfactorsforLNM(P<0.05)bymultivariateanalysis.Theindication,optimumtime,thescopeandmodelofsystematiclymphadenectomywereevaluatedanddiscused.Conclusion:systematiclymphadenectomywassuggestedonlyforearlycaseswithhighriskfactors.Forlatecaseswithresidualtumortheoperationmaybedoneatachosentime,forin-stance,atsecondcytoreductiveorsecond-looksurgery.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
1996年第9期543-547,共5页
Chinese Journal of Obstetrics and Gynecology
关键词
卵巢肿瘤
淋巴转移
淋巴结切除术
OvarianneoplasmsLymphaticmetastasisLymphnodeexcision
