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目的探讨ⅠA2~ⅡA2期宫颈癌盆腔淋巴结转移与主骶韧带浸润的关系。方法收集南方医科大学南方医院等5家医院2004-2014年因宫颈癌行广泛性子宫切除术加淋巴结切除术的2982例患者的临床、病理资料,其中855例符合纳入标准,进行回顾性分析。结果 (1)ⅠA2~ⅡA2期宫颈癌主骶韧带浸润率(3.86%)明显低于盆腔淋巴结转移率(21.05%)。(2)盆腔淋巴结转移与主骶韧带浸润呈正相关(r=0.254,P=0.000),盆腔淋巴结阳性ⅠA2~ⅡA2期宫颈癌患者主骶韧带浸润率(13.9%)明显高于盆腔淋巴结阴性者(1.3%)(χ2=55.147,P=0.000)。(3)盆腔淋巴结转移预测主骶韧带浸润灵敏度72.7%、特异度81.0%、阳性预测值13.3%、阴性预测值98.5%。(4)盆腔淋巴结转移数目不同(0、1、2、≥3个),主骶韧带整体浸润率明显不同(P=0.000),随着盆腔淋巴结转移数目增加,主骶韧带浸润率明显增高。(5)主骶韧带浸润与盆腔淋巴结转移具有同侧性趋势(χ2=31.220,P=0.000)。结论ⅠA2~ⅡA2期宫颈癌主骶韧带浸润与盆腔淋巴结转移具有正相关性和有同侧转移的趋势,盆腔淋巴结转移对主骶韧带浸润具有阴性预测价值。
Objective To investigate the relationship between pelvic lymph node metastases and primary sacral ligament infiltration in patients with stage ⅠA2 ~ ⅡA2 cervical cancer. Methods The clinical and pathological data of 2982 patients with cervical cancer who underwent radical hysterectomy plus lymph node dissection from 2004 to 2014 in Southern Hospital of Southern Medical University from 2004 to 2014 were collected. Among them, 855 cases met the inclusion criteria and were retrospectively analyzed. Results (1) The infiltration rate of primary sacral ligament (3.86%) in stage ⅠA2 ~ ⅡA2 cervical cancer was significantly lower than that of pelvic lymph node (21.05%). (2) The pelvic lymph node metastasis was positively correlated with the infiltration of the main sacral ligament (r = 0.254, P = 0.000). The infiltration rate of the main sacral ligament (13.9%) in patients with pelvic lymph node positive stageⅠA2-ⅡA2 cervical cancer was significantly higher than those with pelvic lymph node negative 1.3%) (χ2 = 55.147, P = 0.000). (3) Prediction of pelvic lymph node metastasis The main sacral ligament invasion sensitivity 72.7%, specificity 81.0%, positive predictive value 13.3%, negative predictive value 98.5%. (4) The number of pelvic lymph node metastasis was different (0, 1, 2, ≥ 3). The overall infiltration rate of the main sacral ligament was significantly different (P = 0.000). The infiltration rate of the main sacral ligament was significantly increased with the increase of pelvic lymph node metastasis. (5) The main sacral ligament infiltration and pelvic lymph node metastasis with ipsilateral sexual tendency (χ2 = 31.220, P = 0.000). Conclusions There is a positive correlation between the infiltration of the main sacral ligament and pelvic lymph node metastasis in ⅠA2 ~ ⅡA2 cervical cancer and the tendency of ipsilateral metastasis. The pelvic lymph node metastasis has a negative predictive value for the invasion of the sacral ligament.