宫颈癌盆腔淋巴结切除临床处理的循证评估

Evidence-based evaluation of the clinical management of pelvic lymph node dissection in cervical cancer

目的分析临床宫颈癌手术淋巴结切除处理方法,对其利弊进行评估。方法回顾2008～2011年3年间105例宫颈癌Ⅲ型子宫切除同时盆腔淋巴切除患者的淋巴病理检查结果,分析盆腔淋巴结切除的临床利弊和病理结果的可靠性。结果 (1)临床上未能了解淋巴结内肿瘤细胞的生物学活性,难以区分细胞是侵入生长或被捕获杀伤凋亡。(2)部分病例切除淋巴结未达到95%切除,每一病例病理报告未达到95%的淋巴切片,阴性结果难以具有统计学意义。(3)术中无法确定1～2mm的淋巴完全切除。(4)文献报道术前CT检查发现淋巴结转移敏感度为66.7%,特异度为100%,漏诊率为33.3%,误诊率为0。结合PET探测结果更加准确。结论 (1)判断淋巴结中的肿瘤细胞是免疫反应还是浸润转移,是盆腔淋巴结切除术必要性的关键之一。(2)"淋巴结病理阴性"结论难有统计学的意义,"淋巴转移阴性结果"只有参考作用。(3)手术可能有阳性淋巴遗漏。(4)CT、PET-CT的影像学阳性诊断指导下淋巴结切除的临床意义会更确定。

Objective To analyse and evaluate pelvic lymph node dissection as the clinical management of the cervical cancer. Methods Reviewed the lymph pathological examination results of 105 patients suffered from cervical cancer and accepted Piver type IU hysterectomy with node dissection from 2008 to 2011. Than analysed the clinical management＇s advantages and disadvantages and reliability of pathological results. Results （1）The biology activity of tumor cells within the lymph node was still uncertain. And it was difficult to distinguish invasive growth cells from the aDoDtosis ones aftercaptured. （2）Not all the paitients got more than 95% the pelvic lymph nodes removed. And not very pathology report con- tain more than 95% lymph nodes removed during the surgery. Therefore a negative biopsy result was difficult to have sta- tistical significance. （3） When lyphm nodes were smaller than 2 mm, it was hard to completely resect all the small nodes. （4） It was reported that the sensitivity, specificity, the missed diagnosis rate and the rate of misdiagnosis of CT examination revealed a lymph node metastasis was 66.7%, 100%, 33.3% and 0, respectively. Combined with the PET detection, thse results must be more accurate. Conclusion （1） To make sure the tumor cells in lymph nodes are just immune response or the infiltration and metastasis ones is one of the most important things of the pelvic lymph node excision. （2） A ＂ negative＂ lymph node pathology report hardly has statistical significance, the ＂ negative ＂ result of lymph node metastasis is reference only. （3） During an operation, there may be some positive lymph omission. （4） The clinical significance of lymph node ex- cision will be more determined, if under the guide of a positive CT or PET-CT radiographic diagnosis.