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目的分析临床宫颈癌手术淋巴结切除处理方法,对其利弊进行评估。方法回顾2008～2011年3年间105例宫颈癌Ⅲ型子宫切除同时盆腔淋巴切除患者的淋巴病理检查结果,分析盆腔淋巴结切除的临床利弊和病理结果的可靠性。结果 (1)临床上未能了解淋巴结内肿瘤细胞的生物学活性,难以区分细胞是侵入生长或被捕获杀伤凋亡。(2)部分病例切除淋巴结未达到95%切除,每一病例病理报告未达到95%的淋巴切片,阴性结果难以具有统计学意义。(3)术中无法确定1～2mm的淋巴完全切除。(4)文献报道术前CT检查发现淋巴结转移敏感度为66.7%,特异度为100%,漏诊率为33.3%,误诊率为0。结合PET探测结果更加准确。结论 (1)判断淋巴结中的肿瘤细胞是免疫反应还是浸润转移,是盆腔淋巴结切除术必要性的关键之一。(2)“淋巴结病理阴性”结论难有统计学的意义,“淋巴转移阴性结果”只有参考作用。(3)手术可能有阳性淋巴遗漏。(4)CT、PET-CT的影像学阳性诊断指导下淋巴结切除的临床意义会更确定。
Objective To analyze the surgical treatment of cervical lymph node dissection and evaluate its advantages and disadvantages. Methods We retrospectively analyzed the lymphatic pathological findings of 105 cases of cervical cancer with type Ⅲ hysterectomy and pelvic lymphadenectomy from 2008 to 2011, and analyzed the clinical advantages and disadvantages of pelvic lymphadenectomy and the reliability of pathological results. Results (1) Clinically failed to understand the biological activity of tumor cells in the lymph nodes, it is difficult to distinguish the cells are invasive growth or capture the killing of apoptosis. (2) Partial resection of lymph nodes did not reach 95% resection, pathological reports of each case did not reach 95% of the lymph nodes, the negative results is difficult to have statistical significance. (3) intraoperative can not determine the complete removal of lymph nodes 1 ~ 2mm. (4) Reported in the literature Preoperative CT examination showed lymph node metastasis sensitivity was 66.7%, specificity was 100%, the rate of missed diagnosis was 33.3%, the misdiagnosis rate was 0. Combined with PET detection results more accurate. Conclusion (1) It is one of the keys to determine the necessity of pelvic lymphadenectomy to determine whether the tumor cells in the lymph nodes are immunoreactive or infiltrating. (2) “Lymphatic pathology negative ” conclusion difficult to have statistical significance, “lymphatic metastasis negative result ” only reference effect. (3) Surgery may have a positive lymphatic leak. (4) The clinical significance of lymph node dissection under CT-PET-CT imaging diagnosis is more certain.