摘要
目的探讨腹膜后淋巴结切除在术中肉眼观察肿瘤局限于卵巢的临床Ⅰ期卵巢上皮性癌中的意义。方法回顾性分析1994年1月至2005年12月北京大学第一医院诊治的89例术中肉眼观察肿瘤局限于卵巢的Ⅰ期卵巢上皮性癌患者的临床资料。因各种原因未接受腹膜后淋巴结切除的45例为第Ⅰ组,接受全面严格分期手术的44例为第Ⅱ组,对两组的临床病理资料包括预后进行比较,并分析影响预后的因素。结果第Ⅱ组中淋巴结阳性者9例(20.4%),低分化癌的淋巴结转移率显著高于高、中分化癌。第Ⅰ组的2年、5年生存率分别为93.3%和91.1%,第Ⅱ组分别为95.4%和90.9%。两组预后差异无统计学意义(P>0.05)。COX逐步回归多因素分析显示,对于行分期手术者,分期对预后有影响,ⅠA期、ⅠB期、ⅠC期较ⅢC期预后好。结论腹膜后淋巴结切除术对术中肉眼观察肿瘤局限与卵巢的临床Ⅰ期卵巢上皮性癌的准确分期有价值,尤其对于低分化癌,但其并不改善患者预后。对于初次手术未行分期手术者,是否需再次手术清扫淋巴结值得探讨。
Objective To investigate the significance of systematic lymphadenectomy in patients with macroscopic stageⅠepithelial ovarian carcinoma.Methods Eighty-nine patients with macroscopic stage Ⅰ epithelial ovarian carcinoma were treated in Peking University First Hospital from January 1994 to December 2005. Patients were divided into two groups based on whether they had undergone lymphadenectomy or not. Forty-five patients who had not undergone lymphadenectomy were assigned into group Ⅰ and the other forty-four patients who had received lymphadenectomy were in group Ⅱ. The clinicopathological features were compared and factors associated with survival were identified.Results Nine patients （20.4%） were lymph node positive in group Ⅱ. The lymph node metastatic rate in patients with poor differentiated ovarian carcinoma was higher than those with well or moderate differentiated carcinoma. The 2 year and 5 year overall survival rate were 93.3% and 91.1%, respectively in group Ⅰ, and were 95.4% and 90.9% in group Ⅱ. The prognosis had no statistically difference between the two groups. Cox regression analysis identified that only stage was the independent prognostic factor for patients who had undergone systematic lymphadectomy. The prognosis in patients with stage ⅠA,ⅠB and ⅠC were better than that in stage ⅢC.Conclusions Lymph node excision is valuable for the accurate surgical staging of macroscopic stageⅠepithelial ovarian carcinoma, especially for the poor differentiated carcinoma. However it could not improve the prognosis of these patients. The significance of second surgery for patients without surgical staging at first operation needs more investigation.
出处
《中国妇产科临床杂志》
2010年第2期105-108,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
