卵巢癌腹膜后淋巴结转移的研究

The Study of Retroperitoneal Lymph Nodes Involvement in Ovarian Carcinoma

目的研究卵巢癌腹膜后淋巴结转移及影响因素。方法我们研究了89例行卵巢癌根治术并行腹主动脉旁淋巴结(PAN)和盆腔淋巴结(PLN)清除术的卵巢癌患者。结果腹膜后淋巴结转移总例数为23例(25.8%)。按临床分期,Ⅰ期转移3例(5.8%),Ⅱ期转移3例(27.3%),Ⅲ期转移12例(60%),Ⅳ期转移5例(83.3%)。临床分期与腹膜后淋巴结转移率间存在相关(P<0.01)。PAN和PLN转移率分别为Ⅰ期3例(5.8%)和0;Ⅱ期3例(23.1%)和1例(9.1%);Ⅲ期10例(50%)和7例(35%);Ⅳ期4例(66.7%)和3例(50%)。PLN转移与PAN转移存在显著相关(P<0.01)。23例腹膜后淋巴结转移患者中,12例仅有PAN转移,3例仅有PLN转移,8例均有PAN和PLN转移。PAN是发生转移最多的部位:肠系膜下动脉以上15例(16.9%),肠系膜下动脉以下13例(14.6%)。转移至髂总淋巴结为8例(9%)、髂外淋巴结7例(7.9%)、腹股沟浅淋巴结6例(6.7%)、闭孔淋巴结5例(5.6%)。结论卵巢癌腹膜后淋巴结转移率包括PAN与PLN与临床分期有关,PAN是卵巢癌淋巴结转移的一级淋巴结,PLN转移与PAN转移有关。

Objective To investigate the retroperitoneal lymph nodes involvement in for nodal in ovarian carcinoma and the influence factors.Methods We studied 89 patients with ovarian carcinoma underwent systematic retroperitoneal lymph node dissection on the pelvic and para-aortic areas.Results Overall incidence of retroperitoneal lymph node metastasis was 23 cases.The case number of lymph node metastasis by stage was 3 in stage Ⅰ,3 in stage Ⅱ,12 in stage Ⅲ and 5 in stage Ⅳ.There was a clear relationship between clinical stage and incidence of lymph node metastasis（P0.01）.The positivity rates for PAN and PLN were 5.9% and 0% in stage Ⅰ,23.1% and 7.7% in stage Ⅱ,55.6% and 33.3% in stage Ⅲ and 71.4% and 42.9% in stage Ⅳ,respectively.Lymph node metastasis to each area was correlated with clinical stage（P0.01 for both PAN and PLN）.Twenty-three of 89 patients had lymph node metastasis.Of these,12 had only PAN metastasis,3 had only PLN metastasis and 8 had nodal involvement in both areas.PAN was most frequently metastasized by ovarian carcinoma,with rates of 15（16.9%） for PAN superior to IMA and 13（14.6%） for PAN inferior to IMA.Positive rates for lymph node groups related to the iliac vessels,i.e.,the common iliac 8（9%）,external iliac 7（7.9%）,lateral deep inguinal 6（6.7%） and obturator node 5（5.6%）.Conclusion The overall incidence of lymph node metastasis include PAN and PLN were correlated with clinical stage,and PAN metastasis were independent risk factors for PLN metastasis（P0.01）.PAN was the fi rst site of lymph node involvement in epithelial ovarian carcinoma.