卵巢癌腹膜后淋巴结转移的特点及其临床意义

Characteristic of retroperitoneal lymph node metastasis of ovarian cancer and its clinical significance

目的:研究卵巢上皮性癌淋巴结转移的解剖学和生物学特点及临床合理治疗。方法:40例Ⅰ期卵巢癌根据清除淋巴结与否分成A、B两组;40例Ⅲ～Ⅳ卵巢癌清除淋巴结20例为C组、不清除淋巴结20例为D组,C、D两组减瘤术后残余癌灶均≤2cm。化疗方法,药物及其剂量基本相同。结果:A组3例腹主动脉旁淋巴结转移者合并盆腔淋巴结转移2例,单纯盆腔淋巴结转移1者,共4例淋巴结转移,转移率20%。A、B两组5年生存率各为95%与80%。C组腹主动脉旁淋巴结转移10例中合并盆腔淋巴结转移9例,单独盆腔淋巴结转移2例,转移率为60%(1220)。C、D两组5年生存率各为55%与15%。5年生存率A、B两组差异有显著意义(P<0.05),C、D两组差异有极显著意义(P<0.001)。结论:卵巢癌淋巴结转移率,随期别而升高,腹主动脉旁与盆腔淋巴结转移率几乎相等,但腹主动脉旁淋巴结转移是主要路线。恰当清除淋巴结可以提高生存率。

Objective：To investigate the anatomical and biological characteristic of lymphatic metastasis and the clinical rational treatment in epithelial ovarian cancer. Methods： dO patients with I stage epithelial ovarian cancer were divided into A and B groups according to whether the lymph nodes were cleared. Other dO patients with stage III were divided into C and D groups. The lymph nodes of C group including 20 patients were cleared and that of D group were not cleared. The residual tumor in C and D group＇ s patients submitted to cytoreductive surgery were smaller than 2 cm in diameter. The projects of chemotherapy and the dose of drug were equal. Results： A group： 3 cases appeared paraaortic lymph node metastasis simultaneously complicating pelvic lymph node metastasis in 2 cases. 1 case occurred pelvic lymph node metastasis alone. The rate of metastasis was 20%. The 5 years sur vival rate of A and B groups were 95% and 80% respectively, there was significant difference between the A and B group （p〈 0.05 ）. The C group＇s rate of metastasis was 60%, 9 of 10 patients with paraaortic lymph node metastasis complicated with pelvic lymph node metastasis. Other 2 patients present pelvic lymph node metastasis alone. The 5 years survival rates of C and D groups were 55% and 15% respectively and the difference between C and D groups was significant （p 〈 0.005）. Conclusion：The metastatic rate of retroperitoneal lymph node is increased according to the stage of cancer. The metastatic rate of paraaortic lymph node is equal to that of pelvic lymph node, but the former is major route of metastasis. The survival rate might be elevated by rational clearance of lymph node.