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目的探讨腹膜后淋巴清扫术在原发性输卵管癌(PFTC)治疗中的作用。方法回顾性分析天津医科大学总医院与天津市中心妇产科医院1995年1月至2008年6月收治的临床资料完整PFTC病例67例,分析腹膜后淋巴清扫术对生存预后的影响并探讨影响PFTC预后的相关因素。结果早期(Ⅰ期和Ⅱ期)患者行腹膜后淋巴清扫者的总生存期(OS)和无进展生存期(PFS)均好于未行腹膜后淋巴清扫者(P=0.020,P=0.025),而晚期患者无论是否行腹膜后淋巴清扫术其OS与PFS差异无统计学意义(P=0.574,P=0.810)。淋巴结阳性患者的OS与PFS均短于阴性者(P<0.001,P<0.001)。临床分期、腹膜后淋巴结转移、术后残余病灶是PFTC生存预后的独立因素(P=0.021,P=0.038,P=0.031)。结论早期PFTC应行包括腹膜后淋巴清扫术在内的全面分期手术,使患者获得准确的手术分期及恰当的术后辅助治疗;晚期病例采取肿瘤细胞减灭术,尽量缩小残余病灶,以延长患者生存期。
Objective To investigate the role of retroperitoneal lymph node dissection in the treatment of primary fallopian tube cancer (PFTC). Methods The clinical data of 67 patients with complete PFTC admitted to Tianjin Medical University General Hospital and Tianjin Central Obstetrics and Gynecology Hospital from January 1995 to June 2008 were analyzed retrospectively to analyze the influence of retroperitoneal lymph node dissection on survival and prognosis PFTC prognosis related factors. Results The patients with retroperitoneal lymph node dissection had better overall survival and progression-free survival (PFS) than those without retroperitoneal lymphadenectomy (P = 0.020, P = 0.025) , While there was no significant difference between OS and PFS in patients with advanced stage regardless of whether they underwent retroperitoneal lymphadenectomy (P = 0.574, P = 0.810). Patients with lymph node positive had shorter OS and PFS than those with negative (P <0.001, P <0.001). The clinical stage, retroperitoneal lymph node metastasis and postoperative residual disease were independent prognostic factors of PFTC (P = 0.021, P = 0.038, P = 0.031). Conclusions Early stage PFTC should be performed with comprehensive staging including retroperitoneal lymphadenectomy so that the patients can get accurate surgical staging and appropriate postoperative adjuvant therapy. In advanced stage, tumor cytoreductive surgery should be performed to minimize the residual lesion so as to prolong the patients’ Survival.