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目的探讨子宫内膜癌的淋巴结转移规律。方法对116例接受了子宫切除及盆腔淋巴结清扫术的子宫内膜癌患者的临床及病理资料进行分析。结果116例中10例有盆腔腔淋巴结转移。与Ⅰ期相比,Ⅱ和Ⅲ期患者的盆腔淋巴结转移率明显升高(P<0.01);肿瘤浸润深肌层、侵犯宫颈及分化不良也会使盆腔淋巴结转移率明显升高(P<0.05)。结论子宫内膜癌淋巴结转移率与临床分期、肌层浸润程度、侵犯宫颈及组织分级相关。转移途径与癌灶部位有关:病灶位于宫体者以髂外淋巴结转移为主;病灶累及宫颈者淋巴结转移则主要在闭孔,髂内、髂外进而至髂总淋巴结。在盆腔各组淋巴结中,闭孔淋巴结组最易受累,其次为髂内、髂外、髂总淋巴结,病灶位于宫底者还有可能跳过髂总淋巴结而直接转移至腹主动脉旁淋巴结。
Objective To investigate the rule of lymph node metastasis in endometrial cancer. Methods The clinical and pathological data of 116 patients with endometrial cancer undergoing hysterectomy and pelvic lymphadenectomy were analyzed. Results In 116 cases, 10 cases had pelvic lymph node metastasis. The pelvic lymph node metastasis rate was significantly higher in patients with stage Ⅱ and Ⅲ than in stage Ⅰ (P <0.01). The invasion of deep myometrium and invasion of cervical and poorly differentiated lymph nodes also significantly increased the pelvic lymph node metastasis (P <0.05) ). Conclusion The rate of lymph node metastasis of endometrial cancer is related to the clinical stage, the degree of myometrial invasion, the invasion of cervical and histological grade. The metastatic pathway is related to the tumor site: the lesions located in the uterus are mainly external iliac lymph node metastasis; the lesions involving the cervical lymph node metastasis are mainly in the obturator, iliac, and external iliac to the total iliac lymph nodes. In each group of pelvic lymph nodes, closed-cell lymph node group most likely to be involved, followed by the iliac, external iliac, common iliac lymph nodes, the lesion in the uterus may skip the common iliac lymph nodes and directly transferred to the abdominal aorta lymph nodes.