Ⅰ、Ⅱ期子宫颈癌的淋巴结转移及治疗

The Treatment of Lymph Nodes Metastases of Stage Ⅰand Ⅱ Cervical Carcinoma

目的：探讨Ⅰ、Ⅱ期子宫颈癌转移淋巴结的治疗方法。方法：８４例全部行广泛性子宫切除和盆腔淋巴结清扫术，１８例腹主动脉旁转移者也行系统性淋巴清扫。８４例中，采用输尿管外侧游离法者４５例，采用Ｗｅｒｔｈｅｉｍ－Ｍｅｉｇｓ法者３９例。４０例术前行淋巴造影和染色。术后辅以放射治疗和化疗。结果：随访５年以上者７７例，存活率为７１．４％。１个淋巴结转移者存活率为８５．７％，２个以上转移者为６３．３％；淋巴造影者存活率为８０．０％，无淋巴造影者为６２．２％。行输尿管外侧游离法者主韧带淋巴结复发率为２．２％，行Ｗｅｒｔｈｅｉｍ－Ｍｅｉｇｓ法为１７．９％；腹主动脉区转移者存活率为５２．９％。结论：输尿管外侧游离法切除主韧带及其淋巴结、术前淋巴造影和染色以及腹主动脉区淋巴清扫，均可减少转移淋巴结残留及提高疗效。

Objective: To investigate the treatment methods of nodal metastases of stages Ⅰ and Ⅱ cervical carcinoma. Methods: Surgical data of 84 patients with stages Ⅰ and Ⅱ cervical carcinoma were analyzed. All patients underwent extensive abdominal hysterectomy and bilateral pelvic lymphadenectomy, 18 of whom received systematic resection of periaortic metastatic lesions. The method of isolation of the ureters from lateral exterior were performed on 45 patients. Wertheim Meigs′ operation was performed in 39 patients and preoperative lymphangiography and dyeing in 40 patients, followed by radiotherapy and chemotherapy. Results: 77 cases were followed up for more than five years, 55 (71.4%) were alive. In the patients with one node involved, the survival rate was 85.7%, and in those with two or more nodes involved it was 63.3%. The survival rate of the lymphangiography group was 80.0%, and that of the control group 62.2%. The recurrent rate of cardinal ligament nodes was 2.2% in the patients with lateral isolation of the ureters and was 17.9% in the Wertheim Meigs′ group. The survival rate of patients with periaortic metastasesis was 52.9%. Conclusions: Lateral isolation of the ureters and resection of cardinal ligaments with their lymph nodes preoperative lymphangiography and dyeing, and resection of periaortic metastatic nodes could reduce nodal recurrence and raise the five year survival rate.