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目的探讨子宫内膜癌扩散至盆腔和腹主动脉旁淋巴结的途径。方法对接受全子宫和盆腔淋巴结切除术的168例子宫内膜癌患者,准确记录肿瘤所处子宫腔位置、子宫肌层浸润深度、分期、病理类型、细胞学分级及切除淋巴结位置及阳性淋巴结数,并进行相关分析。结果肿瘤位于宫底部、宫体部、累及宫颈者子宫内膜癌淋巴结转移率分别是19.2%、20.6%、37.5%,均以髂外淋巴结转移为最常见。病灶局限于宫底、宫体部者多为髂外、闭孔淋巴结转移;累及宫颈者以髂外、髂总淋巴结转移为常见。前者髂总淋巴结转移率为30.8%,后者为66.7%,P<0.01。所有腹主动脉旁淋巴结阳性和累及宫颈者的髂总淋巴结均为阳性,而病灶限于宫体的腹主动脉旁淋巴结转移者仅有27%髂总淋巴结阳性。肌层浸润程度、病理类型及细胞分化程度与盆腔淋巴结转移密切相关。结论位于宫体部的肿瘤可直接或由宫颈转移至髂外淋巴结,宫颈受累者最易发生髂总和髂外淋巴结转移。病灶累及宫颈者髂总淋巴结可作为腹主动脉旁淋巴结的前哨淋巴结。
Objective To explore the pathways of endometrial cancer spreading to pelvic and abdominal aorta lymph nodes. Methods 168 cases of endometrial cancer undergoing total hysterectomy and pelvic lymphadenectomy were enrolled in this study. The location of uterine cavity, depth of myometrium invasion, staging, pathological type, cytological grade, lymph node location and positive lymph nodes , And make relevant analysis. Results The tumor was located in the bottom of the palace. The lymph node metastasis rates of the endometrium and uterus, involving the cervix, were 19.2%, 20.6% and 37.5%, respectively. Most of the metastases were external iliac lymph nodes. Focal lesions confined to the end of the Palace, Palace body mostly iliac, closed-cell lymph node metastasis; involved in the external iliac, iliac lymph node metastasis as common. The former total iliac lymph node metastasis rate was 30.8%, the latter was 66.7%, P <0.01. All of the para-aortic lymph nodes and those involving the cervix were positive for the common iliac lymph nodes, while only 27% of the common iliac lymph nodes were localized to the para-aortic lymph node metastasis of the uterus. Myometrial invasion, pathological type and degree of cell differentiation are closely related to pelvic lymph node metastasis. Conclusion The tumor located in the body part of the body can be directly transferred from the cervix to the external iliac lymph node, and the most affected part of the cervix is iliac total and external iliac lymph node metastasis. Cervical lesions involving the common iliac lymph nodes can be used as a para-aortic lymph node sentinel lymph nodes.