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[目的]评价前哨淋巴结(SLN)对肿瘤>2cm的Ⅰb1期宫颈癌患者盆腔淋巴结转移状态的预测价值,并探讨SLN检测结果指导经腹广泛性宫颈切除术(RAT)的临床意义。[方法]对45例保留生育功能治疗的肿瘤>2cm的Ⅰb1期宫颈癌患者,术中检测SLN并原位切除,送快速冰冻病理检查排除盆腔淋巴结转移后,行RAT和盆腔淋巴清扫,术后将SLN和盆腔其他淋巴结送常规病理检查和抗角蛋白免疫组化检测。观察患者手术时间、术中出血量、术中术后并发症及术后复发、妊娠情况等指标,评价SLN检测指导肿瘤>2cm的Ⅰb1期宫颈癌患者行RAT手术的可行性和安全性。[结果]45例患者均检出SLN,共检出145枚,平均3.2枚/例,检出率100.0%(45/45)。4例因术中快速冰冻病理发现SLN转移而改行广泛性子宫切除+盆腔淋巴清扫术,其余41例均成功行RAT。术后病理检查发现1例有1枚非SLN转移,SLN假阴性率为2.2%(1/45),SLN阴性预测值为97.6%(40/41)。抗角蛋白免疫组化检测未检出常规病理检查漏诊的微转移灶。SLN术中冰冻病理和术后病理的符合率为97.8%(44/45)。术中2例损伤一侧子宫动脉、1例损伤膀胱肌层,术后7例出现盆腔淋巴囊肿,3例残余宫颈管狭窄。术后完成随访38例,中位随访时间61个月,随访率为92.7%。术后19例有生育要求,5例妊娠,妊娠率26.3%。随访期间,2例复发,复发率为5.3%(2/38)。[结论]SLN检测结果能准确预测肿瘤>2cm的Ⅰb1期宫颈癌患者的盆腔淋巴结转移状态。希望保留生育功能的肿瘤>2cm的Ⅰb1期宫颈癌患者,在SLN检测结果指导下行RAT是安全可行的。
[Objective] To evaluate the predictive value of sentinel lymph node (SLN) on the status of pelvic lymph node metastasis in patients with Stage Ⅰ 1b cervical cancer with tumor> 2cm and to explore the clinical significance of SLN test in guiding general abdominal resection (RAT). [Method] Forty-five patients with stage Ⅰ 1b cervical cancer who had fertility treatment function> 2cm were examined with SLN and resected in situ. RAT and pelvic lymph node dissection were performed after rapid pelvic lymph node metastasis was removed by rapid frozen pathology. SLN and other pelvic lymph nodes to send routine pathological examination and anti-keratin immunohistochemistry. To observe the operation time, intraoperative blood loss, intraoperative and postoperative complications and postoperative recurrence, pregnancy and other indicators to evaluate the feasibility and safety of SLAT detection in patients with stage Ⅰ b1 cervical cancer> 2cm. [Results] All 45 patients were detected SLN, a total of 145 were detected, an average of 3.2 / case, the detection rate was 100.0% (45/45). In 4 cases, extensive hysterectomy and pelvic lymphadenectomy were performed due to intraoperative rapid freezing pathological findings of SLN metastasis, and the remaining 41 cases were successfully performed RAT. One case had non-SLN metastasis in one case. The false negative rate of SLN was 2.2% (1/45) and the negative predictive value of SLN was 97.6% (40/41). Anti-keratin immunohistochemical detection did not detect routine pathological examination missed diagnosis of micrometastasis. The coincidence rate of frozen pathology and postoperative pathology in SLN was 97.8% (44/45). Intraoperative 2 cases of damage to the uterine artery, 1 case of bladder muscle injury, pelvic lymphatic cyst in 7 cases, 3 cases of residual cervical stenosis. Thirty-eight follow-up cases were completed, with a median follow-up of 61 months and a follow-up rate of 92.7%. Postoperative 19 cases have fertility requirements, 5 cases of pregnancy, the pregnancy rate was 26.3%. During follow-up, 2 patients relapsed with a recurrence rate of 5.3% (2/38). [Conclusion] The results of SLN can accurately predict the pelvic lymph node metastasis status of patients with stage Ⅰ 1b cervical cancer with tumor> 2cm. Hope to retain the reproductive function of tumors> 2cm Ⅰb1 cervical cancer patients, SLN test results under the guidance of RAT is safe and feasible.