Girardi F, Pickel H, Winter R
Department of Obstetrics and Gynecology, University of Graz, Austria.
Gynecol Oncol. 1993 Sep;50(3):330-3. doi: 10.1006/gyno.1993.1220.
Between 1971 and 1989 a total of 420 patients underwent radical abdominal hysterectomy with pelvic lymphadenectomy at our hospital for stage Ib, IIa, or IIb cervical cancer. The entire lymph node material was processed in serial sections and stained with hematoxylin and eosin. Lymph nodes were counted and the sizes of metastases measured. The entire surgical specimen was fixed as a whole with the parametria spread out. The size of the tumor was measured by morphometry. Cases treated between 1971 and 1979 were compared with those treated between 1980 and 1989. The median number of pelvic lymph nodes removed per patient was 24 between 1971 and 1979 and 35 between 1980 and 1989 (P = 0.0001). Significantly more nodes were removed at each node group (P = 0.01). Between 1971 and 1979 no common iliac nodes were obtained in 56 patients and no left common iliac nodes in 74 patients, compared to only 1 and 6 patients, respectively, between 1980 and 1989. The rate of patients with positive lymph nodes was 33% (63/195) between 1971 and 1979 and 55% (101/225) between 1981 and 1989 (P = 0.008). In the first study period the median number of parametrial lymph nodes was 2 compared to 3 in the second period. The rate of patients with positive parametrial lymph nodes increased from 15 to 24% (P = 0.027). The results of this review indicate that exacting morphologic processing of the entire lymphatic tissue obtained at surgery permits accurate postoperative staging and assessment of risk factors for decisions on adjuvant treatment. Histologic evaluation objectifies the radicality of the procedure and is useful in the quality control of the surgical treatment of cervical cancer.
1971年至1989年间，我院共有420例Ib期、IIa期或IIb期宫颈癌患者接受了根治性腹式子宫切除术及盆腔淋巴结清扫术。所有淋巴结组织均制成连续切片，并用苏木精和伊红染色。对淋巴结进行计数并测量转移灶大小。整个手术标本连同展开的宫旁组织一起整块固定。通过形态测量法测量肿瘤大小。将1971年至1979年期间治疗的病例与1980年至1989年期间治疗的病例进行比较。1971年至1979年期间，每位患者切除的盆腔淋巴结中位数为24个，1980年至1989年期间为35个（P = 0.0001）。每个淋巴结组切除的淋巴结明显更多（P = 0.01）。1971年至1979年间，56例患者未获取到髂总淋巴结，74例患者未获取到左髂总淋巴结，而1980年至1989年间分别仅有1例和6例患者未获取到。1971年至1979年间淋巴结阳性患者的比例为33%（63/195），1981年至1989年间为55%（101/225）（P = 0.008）。在第一个研究期间，宫旁淋巴结的中位数为2个，而在第二个期间为3个。宫旁淋巴结阳性患者的比例从15%增至24%（P = 0.027）。本综述结果表明，对手术获取的整个淋巴组织进行严格的形态学处理有助于准确的术后分期以及评估辅助治疗决策的风险因素。组织学评估可客观体现手术的根治程度，有助于宫颈癌手术治疗的质量控制。
