【摘要】 目的：探讨子宫内膜癌腹膜后淋巴结转移的特点及危险因素，为临床选择术式提供依据。方法：收集１９８６年１月～１９９８年１２月行广泛性全子宫双附件切除加腹膜后淋巴结清扫的１４８例子宫内膜癌病例，分析临床病理因素与淋巴结转移的关系及淋巴结转移的特点。结果：盆腔淋巴结转移率为２２．９７％（３４／１４８），最常见的转移部位为髂内和骼外淋巴结；腹主动脉旁淋巴结转移率为２８．００％（１４／５０），最常见的转移部位是骶前和相当于肠系膜下动脉起始处高度的淋巴结。子宫内膜腺癌、腺鳞癌和装液性乳头状腺癌盆腔淋巴结转移率分别为１６．７０％、４０．００％、５２．１７％（Ｐ＜０．０５）；腹主动脉旁淋巴结转移率分别为１４．８１％、５０．００％、５０．００％（Ｐ＜０．０１）。当子宫外有病灶时盆腔淋巴结转移率为 ７４．１０％、腹主动脉旁淋巴结转移率为４４．４０％，子宫外无病灶时盆腔淋巴结转移率为 １１．６０％，腹主动脉旁淋巴结转移率为８．７０％，前后相比 Ｐ＜０．００１。细胞分化Ⅲ级者盆腔淋巴结转移率为 ５７．１４％；腹主动脉旁淋巴结转移率为 ５６．５２％与细胞分化Ⅰ、Ⅱ级相比 Ｐ＜０．００１。子宫旁脉管有浸润者盆腔淋巴结转移率为 ８４．２１％，腹主更多还原

【Abstract】 Objective: To study the characteristics and risk factors of retroperitoneal lymph node metastasis in primary endometrial carcinoma and to provide basis of selecting a rational operative mode. Methods: From Jan 1986 to Dec 1998, 148 patients with primary endometrial carcinoma treated by extensive hysterectomy and retroperitoneal lymphadenectomy in our hospital were retrospectively analysed. We sudied the clinical pathologic factors, the characteristics of retroperitoneal lymph node metastasis and the relationship between them. Results: The total incidence of pelvic lymph node (PLN) metastasis was 22.97% (34/148) with the most frequent metastatic positions being the internal and external iliac lymph nodes. The metastatic rate of para-aortic lymph nodes (PANwas28.0% (14/50) with the most frequent metastatic site of anterior iliac and the initiation of inferior mesenteric artery. The PLN metastatic rates of adenocarcinoma of endometrium, adeno-squamous cell carcinoma, serous papillo-adenocarcinoma were 16.7%,40%, 47.83% (P<0.05) and the paraaortic lymph node metastatic rates of them were 14.81%, 50.20%, 50% (P<0.01) respectively. When there were diseases out of the uterus, the metastatic rates of PLN and PAN were 74.1% and 44.4% respectively, when no diseases existed out of the uterus, the rates were 11.0% and 8.7% (P<0.001) respectively. The metastatic rates of PLN and PAN in GradeⅢ were 57.14% and 56.52% as compared with Grade Ⅰ and Grade Ⅱ (P<0.001). With positive vascular invasion beside the uterus, the PLN and PAN metastatic rates were 84.21% and 26.92% respectively, while compared with no para-uterus vascular invasion P<0.001 and P<0.05 respectively. When the tumor invasion exceeded half of the myometrium, the metastatic rates of PLN and PAN were 56.25% and 37.14% (P<0.001, P<0.05). As the primary disease located below the uterine corpus, the metastatic rates of PLN and PAN were 34% and 36.4% (P<0.05, P< 0.05) respectively. Conclusion: Adeno-squamous cell carcinoma, serous papillary carcinoma, the diseases out of uterusand the tumor cell differentiation degree are the main risk factors of metastasis to PAN; Para-uterus vascular invasion is the most important and independent risk factors of PLN metastasis. The location of primary disease and the depth of myometrial invasion are closely related with PLN metastasis. Radical hysterectomy plus systematic retroperitoneal lymphadenectomy should be applied to patients with high risk factors to improve the life quality of patients and it is helpful to stage the differentiation of tumor cell and to guide the rational treastment.更多还原