子宫颈癌综合治疗后腹主动脉旁合并或不合并锁骨上淋巴结转移的临床分析

Clinical analysis of paraaortic combined with or not supraclavicular lymph node metastasis in patients with cervical cancer after combined treatment

目的分析子宫颈癌综合治疗后出现腹主动脉旁合并或不合并锁骨上淋巴结转移的临床特征、治疗和预后。方法对20例出现腹主动脉旁合并或不合并锁骨上淋巴结转移的子宫颈癌患者的临床资料进行回顾性分析。结果20例患者初诊时均行以下一项或二项检查：磁共振成像（MRI）、计算机层析成像（CT）、单光子发射型计算机断层显像（SPECT），未发现远处淋巴结转移。在手术、放化疗等综合治疗后，于观察期2年内，最短2个月开始出现转移，其中1例黏液腺癌为治疗中进展，开始治疗到死亡时间为6个月。15例为单纯腹主动脉旁淋巴结转移，其中4例为腹主动脉旁淋巴结放疗后3～6个月又出现左锁骨上淋巴结转移。4例为腹主动脉旁及左锁骨上淋巴结同时发现转移。20例病例中，复发放弃治疗的7例均在2年内死亡，中位生存时间为7．50个月；复发有治疗的13例，中位生存时间18．98个月，两者差异有统计学意义（X^2=7．23，P〈0．01）。结论子宫颈癌综合治疗后出现腹主动脉旁合并或不合并锁骨上淋巴结转移患者经再治疗可明显延长生存期，有积极治疗意义。

Objective To analysis the clinical characteristics, treatment and prognosis for patients with cervical cancer with lymph lode of paraaortic and/or supraclavicular metastasis after combined treatment in two years. Methods Data of 20 patients with lymph lode of paraaortic and/or supraclavicular metastasis of cervical cancer were analyzed retrospectively. Results There was no evidence of lymph node of paraaortic and supraclavicular metastasis before the first combined treatments according to the MRI/CT/SPECT scans in these 20 patients. However, lymph lode of paraaortic and/or supraclavicular metastasis were seen in two years after treatments, the shortest is two months. One patient was progressing during treatment whose pathologic diagnosis is mucinous adenocarcinoma, died in 6 months from treatment start. There was only paraaortic metastasis in 15 patients, among these, 4 patients were found lymph lode of left supraclavical metastasis after retreatments in 3-6 months. Both paraaortic and left-supraclavical lymph node metastasis in 4 cases. Among these 20 cases, recurrence and to give up treatment, whose median survival time is 7.50 months, recurrence and to gain treatment, whose median survival time is 18.98 months, there was significant difference （X^2=7.23, P〈0.01）. Conclusion Patients with cervical cancer with lymph lode of paraaortic and/or supraclavicular metastasis after combined treatment will obviously extend survival time after retretments, which has positive therapy significance.