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早期子宫颈癌根治术联合腹主动脉旁淋巴结清扫术的临床意义
作者:陈靖汶  李玉芝  刘梦君  郭祥瑞 
单位:蚌埠医学院第一附属医院妇科肿瘤  安徽 蚌埠 233000 
关键词:宫颈肿瘤/外科学 腹主动脉旁淋巴结清扫术 宫颈癌根治术 回顾性研究 
DOI:R737.33;R730.56
出版年,卷(期):页码:2018,33(2):165-169
摘要:

目的 探讨早期子宫颈癌根治术+腹主动脉旁淋巴结清扫术的临床意义。方法 回顾性分析行手术治疗的200例早期子宫颈癌患者,其中行子宫颈癌根治术+腹主动脉旁淋巴结清扫术的60例为治疗组,行传统子宫颈癌根治术140例患者为对照组。按照NCCN指南术后给予辅助治疗,观察比较两组术中出血量、手术时间、手术并发症发生率、术后肿瘤复发率及生存率。结果 治疗组手术时间和术中出血量分别为(176.85±19.86) min和(246.79±27.83) mL,对照组分别为(168.58±17.55) min和(215.95±16.24) mL,两组比较差异均无统计学意义(均P>0.05)。治疗组并发症发生率为18.3%(12/60),对照组为17.1%(24/140),差异无统计学意义(P>0.05)。治疗组复发率为16.7%,对照组复发率为33.5%,差异具有统计学意义(P<0.05)。治疗组4年生存率为91.7%,对照组为80.0%,差异具有统计学意义(P<0.01)。盆腔淋巴结转移数 ≥ 2枚和治疗前血鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC)>1.96 ng/mL时,腹主动脉旁淋巴结阳性率均更高(均P<0.05)。结论 腹主动脉旁淋巴结阳性率与治疗前血SCC水平、盆腔淋巴结转移数有关,子宫颈癌腹主动脉旁淋巴结清扫可以延长总生存率,减少复发率。

Objective To investigate the efficacy of early cervical cancer radical resection combined with abdominal aortic lymph node dissection. Methods Two-hundred early cervical cancer patients who received surgical treatment were retrospectively analyzed. Among them, 60 patients underwent cervical cancer radical surgery combined with abdominal aortic lymph node dissection and were categorized as the treatment group, and 140 patients underwent traditional cervical cancer radical surgery and were categorized as the control group. The patients were treated with adjuvant therapy according to NCCN guidelines. The intraoperative blood loss, operation time, operation complications, recurrence rate and survival rate were compared. Results The operation time and intraoperative blood loss were (176.85±19.86)min and (246.79±27.83)mL in the treatment group, and were (168.58±17.55)min and (215.95±16.24)mL in the control group. No significant difference was observed between the two groups (P>0.05). Besides, the incidences of complications were also comparable between the treatment group and the control group[12/60 (18.3%) vs 24/140 (17.1%), P>0.05]. Nevertheless, the relapse rate of the treatment group was significantly different compared with the control group (16.7% vs 33.5%, P<0.05). The 4-year survival rate was also significantly different between the treatment group and the control group (91.7% vs 80.0%, P<0.01). Finally, the positive rate of para-aortic lymph nodes was higher when the number of pelvic lymph node metastasis ≥ 2 or pretreatment blood SCC>1.96 ng/mL (both P<0.05). Conclusion The positive rate of abdominal aortic lymph nodes is related to the level of pretreatment blood SCC and the number of pelvic lymph node metastasis. Lymph node dissection of para-aortic region can prolong the overall survival rate and reduce the recurrence rate of cervical cancer.

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