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目的:用活性染料美兰定位进行子宫颈癌前哨淋巴结活检(Sentinel lymph node biopsy,SLNB),了解SLN的分布特点,探索SLN检测的可行性及其临床病理学意义。方法:对45例术前确诊宫颈癌、FIGO分期Ia2-Ⅱb的患者行经腹根治性子宫切除术加盆腔淋巴结清扫术加术中美兰识别SLN,将最先蓝染的淋巴结定为SLN,切除SLN送病理检查。SLN病理学评估包括连续切片中的病理诊断和广谱细胞角蛋白免疫组化检测证实。所有数据采用Stata7.0统计软件进行统计学分析,检验水准α=0.05。结果:①宫颈癌中识别和检获SLN41例占91.11(41/45),由SLN发现转移率的灵敏度为85.71(6/7);②闭孔淋巴结是宫颈癌SLN最常见部位,占检获SLN的55.04,其次髂内和髂外淋巴结分别为20.18和14.67;③癌转移SLN平均直径为(2.87±0.17)cm,显著大于无癌转移的SLN(1.57±0.05)cm;④SLN阳性检出率与宫颈癌FIGO分期、宫颈肌层浸润深度、颈管浸润呈显著正相关(均P<0.05)。结论:SLN能反映宫颈癌盆腔LN的转移情况与常见部位,并可作为确定手术范围的依据之一,有利于患者预后的评价。但染料注射时间、部位还需进一步探究与改进,以提高宫颈癌术中对SLN的判别检出率。宫颈癌根治术美兰定位检测SLN安全、可行。
OBJECTIVE: To determine the distribution of SLN by Sentinel lymph node biopsy (SLNB) using reactive dye melanin localization and to explore the feasibility of SLN detection and its clinicopathological significance. Methods: 45 cases of preoperatively diagnosed cervical cancer, FIGO staging Ia2-Ⅱb patients underwent radical radical hysterectomy plus pelvic lymph node dissection plus intramedullary identification SLN, the first blue-stained lymph nodes as SLN, resection SLN send pathological examination. Pathological evaluation of SLN includes pathological diagnosis in serial sections and extensive cytokeratin immunohistochemistry. All data using Stata7.0 statistical software for statistical analysis, test level α = 0.05. Results: ①41 (41/45) SLNs were identified and seized in cervical cancer, the sensitivity of SLN was 85.71 (6/7). ② Obturator lymph nodes were the most common sites of SLN in cervical cancer, which accounted for SLN 55.04, followed by internal iliac and external iliac lymph nodes were 20.18 and 14.67, respectively. The mean diameter of SLN was (2.87 ± 0.17) cm, which was significantly higher than that of non-metastatic SLN (1.57 ± 0.05) cm. Cancer FIGO staging, cervical myometrial invasion depth, neck canal infiltration were significantly correlated (all P <0.05). CONCLUSIONS: SLN can reflect the pelvic LN metastasis and common sites of cervical cancer and can be used as a basis for determining the surgical range, which is in favor of the evaluation of prognosis. However, dye injection time, the site needs further exploration and improvement in order to improve cervical cancer detection of SLN discrimination. Cervical cancer Melanoma localization SLN safe and feasible.