孫墨紅 苑中甫(通訊作者)

452470登封市婦幼保健院婦科1 450052河南省鄭州大學(xué)第一附屬醫(yī)院2

Ⅲc期卵巢癌淋巴結(jié)轉(zhuǎn)移對(duì)患者預(yù)后的影響

孫墨紅1，2苑中甫(通訊作者)2

452470登封市婦幼保健院婦科1450052河南省鄭州大學(xué)第一附屬醫(yī)院2

目的：探討Ⅲc期卵巢癌淋巴結(jié)轉(zhuǎn)移對(duì)患者預(yù)后的影響。方法：收治Ⅲc期卵巢癌患者40例，進(jìn)行隨訪觀察，記錄疾病進(jìn)展情況。結(jié)果：40例患者中，盆腔淋巴結(jié)轉(zhuǎn)移10例中，3年生存率90.0%，5年生存率80.0%；30例腹膜轉(zhuǎn)移中，3年生存率56.70%，5年生存率36.7%。殘留病灶＜1 cm 24例中，3年生存率79.2%，5年生存率54.2%；殘留病灶＞1 cm 16例中，3年生存率43.8%，5年生存率18.8%。腹膜轉(zhuǎn)移生存率明顯低于盆腔淋巴結(jié)轉(zhuǎn)移(P＜0.05)，殘留病灶＞1 cm患者生存率明顯低于殘留病灶＜1 cm患者(P＜0.05)。結(jié)論：腹膜轉(zhuǎn)移生存率明顯低于盆腔淋巴結(jié)轉(zhuǎn)移，殘留病灶＞1 cm患者生存率明顯低于殘留病灶＜1 cm的患者。

Ⅲc期卵巢癌；淋巴結(jié)轉(zhuǎn)移；腹膜轉(zhuǎn)移；生存率

卵巢癌是女性生殖器官常見的腫瘤之一[1]，死亡率較高[2]，對(duì)婦女生命造成嚴(yán)重威脅。卵巢癌擴(kuò)散的主要途徑之一是淋巴結(jié)轉(zhuǎn)移[3]，宮頸癌國(guó)際婦產(chǎn)科聯(lián)盟(FIGO)分期系統(tǒng)將存在淋巴轉(zhuǎn)移的患者劃分為Ⅲc期[4]。2011年2月-2012年5月收治Ⅲc期卵巢癌患者40例，進(jìn)行回顧性分析，現(xiàn)報(bào)告如下。

資料與方法

2011年2月-2012年5月收治Ⅲc期卵巢癌患者40例，年齡28～73歲，平均(39.6±5.2)歲。所有患者均接受規(guī)范性手術(shù)治療，術(shù)后無(wú)病灶殘留或者殘留灶＜1 cm 24例(60.0%)，術(shù)后殘留灶＞1 cm 16例(40.0%)。腹腔腹膜種植直徑＞2 cm不考慮淋巴結(jié)轉(zhuǎn)移者30例，有盆腔淋巴結(jié)轉(zhuǎn)移者10例。

方法：對(duì)所有患者進(jìn)行隨訪觀察，并記錄疾病進(jìn)展情況。

結(jié) 果

40例Ⅲc期卵巢癌患者3年、5年生存率情況：盆腔淋巴結(jié)轉(zhuǎn)移10例中，3年生存9例，3年生存率90.0%；5年生存8例，5年生存率80.0%。30例腹膜轉(zhuǎn)移中，3年生存17例，3年生存率56.70%；5年生存11例，5年生存率36.7%。殘留病灶＜1 cm 24例中，3年生存19例，3年生存率79.2%；5年生存13例，5年生存率54.2%。殘留病灶＞1 cm 16例中，3年生存7例，3年生存率43.8%；5年生存3例，5年生存率18.8%。腹膜轉(zhuǎn)移生存率明顯低于盆腔淋巴結(jié)轉(zhuǎn)移的患者，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。殘留病灶＞1 cm患者生存率明顯低于殘留病灶≤1 cm的患者，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)，見表1。

討 論

卵巢癌淋巴結(jié)轉(zhuǎn)移途經(jīng)主要有3條途經(jīng)[5]：①沿卵巢血管上行注入腹主動(dòng)脈旁淋巴結(jié)或腰淋巴結(jié)；②沿闊韌帶下行注入髂內(nèi)、髂外、髂間或髂總淋巴結(jié)，不論上行路線是否受阻，實(shí)際上兩條途經(jīng)常同時(shí)存在，這可以解釋臨床上卵巢癌盆腔淋巴結(jié)轉(zhuǎn)移和腹主動(dòng)脈旁淋巴結(jié)轉(zhuǎn)移的機(jī)會(huì)幾乎相等；③極少數(shù)沿圓韌帶注入髂外尾部和腹股溝淋巴結(jié)。及時(shí)和準(zhǔn)確的診斷是否有腹膜后淋巴結(jié)轉(zhuǎn)移，對(duì)治療和預(yù)后有著重要的臨床意義。

本組資料通過(guò)對(duì)40例Ⅲc期卵巢癌患者進(jìn)行隨訪觀察，結(jié)果發(fā)現(xiàn)，盆腔淋巴結(jié)轉(zhuǎn)移10例中，3年生存9例，3年生存率90.0%；5年生存8例，5年生存率80.0%。30例腹膜轉(zhuǎn)移中，3年生存17例，3年生存率56.70%；5年生存11例，5年生存率36.7%。殘留病灶＜1 cm 24例中，3年生存19例，3年生存率79.2%；5年生存13例，5年生存率54.2%。殘留病灶＞1 cm 16例中，3年生存7例，3年生存率43.8%；5年生存3例，5年生存率18.8%；腹膜轉(zhuǎn)移生存率明顯低于盆腔淋巴結(jié)轉(zhuǎn)移的患者，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。殘留病灶＞1 cm患者生存率明顯低于殘留病灶＜1 cm的患者，差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。由此可見，腹膜轉(zhuǎn)移生存率明顯低于盆腔淋巴結(jié)轉(zhuǎn)移的患者，殘留病灶＞1 cm患者生存率明顯低于殘留病灶≤1 cm的患者。

表1 患者預(yù)后分析[n(%)]

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Influence of lymph node metastasis on prognosis of patients withⅢc stage ovarian cancer

Sun Mohong1，2,Yuan Zhongfu(Corresponding author)2
Department of Gynaecology,the Maternal and Child Health Hospital of Dengfeng City 4524701Department of Gynaecology,the First Affiliated Hospital of Zhengzhou University,Henan Province 4500522

Objective:To explore the influence of lymph node metastasis on prognosis of patients withⅢc stage ovarian cancer.Methods:40 patients withⅢc stage ovarian cancer were selected.We followed up and recorded the progress of the disease.Results:In the 40 patients,there were 10 cases with pelvic lymph node metastasis.The 3-year survival rate was 90%,and the 5-year survival rate was 80%.There were 30 cases with peritoneal carcinomatosis.The 3-year survival rate was 56.70%,and the 5-year survival rate was 36.7%.There were 24 cases with residual lesion less than 1 cm.The 3-year survival rate was 79.2%,and the 5-year survival rate was 54.2%.There were 16 cases with residual lesion more than 1 cm.The 3-year survival rate was 43.8%,and the 5-year survival rate was 18.8%.The survival rate of peritoneal metastasis was significantly lower than that of pelvic lymph node metastasis(P＜0.05).The survival rate of patients with residual lesion less than 1 cm was significantly lower than that of patients with residual lesion more than 1 cm(P＜0.05).Conclusion:The survival rate of peritoneal metastasis was significantly lower than that of pelvic lymph node metastasis.The survival rate of patients with residual lesion less than 1 cm was significantly lower than that of patients with residual lesion more than 1 cm.

Ⅲc stage ovarian cancer;Lymph node metastasis;Peritoneal metastasis;Survival rate

10.3969/j.issn.1007-614x.2017.35.11