乳腺癌前哨淋巴结活检常用染料效果实验研究

Experimental study of the choice of vital dyes for sentinel lymph node biopsy in breast cancer

目的通过动态观察国内外最常使用的3种生物活性染料:1%异硫蓝(isosulfanblue,IB)、1%专利蓝(patentblue,PB)及1%美蓝(methyleneblue,MB)在大耳白家兔第二对乳腺至腋窝淋巴系统的运行特性,为临床选取理想的染料示踪剂行乳腺癌前哨淋巴结活检(sentinellymphnodebiopsy,SLNB)提供实验依据。方法30只雌性大耳白家兔随机分为3组,每组10只。全麻后,首先分离皮瓣,暴露部分第二对乳腺、连接乳腺与腋窝淋巴结之间的淋巴管以及腋窝,向第二对乳腺注射不同染料0.1ml,取染料经淋巴管到达的第一站淋巴结为前哨淋巴结(sentinellymphnode,SLN),观察SLN和第二站淋巴结染色的时间、淋巴结染色枚数以及淋巴结的褪色时间。结果注射后,染料到达腋窝第一站淋巴结的时间以IB组最长,平均为20.6秒;PB组其次,平均16.8秒;MB组最短,平均14.7秒,组间比较差异明显(P=0.040)。腋窝淋巴结染色枚数3组无明显差异(P=0.235)。肉眼观,淋巴结染色以MB组最深,IB组次之,而PB组最浅。第二站淋巴结染色时间IB最长,平均45.8秒,PB为40.6秒,两者比较无差异(P=0.257),MB最短,为23.5秒,与前两者比较差异明显(均为P=0.000)。蓝染淋巴结的褪色时间以PB组最短,6.384±0.944分钟明显褪色,于32.3±3.3分钟完全褪色;IB组次之,33.9±2.8分钟可见明显褪色,于64.2±2.4分钟完全褪色;MB组最长,观察至6小时淋巴结仍呈深染,组间比较差异明显(均为P=0.000)。结论MB到达SLN时间较短,淋巴结染色鲜明且持久,IB和PB在SLN中停留时间较长,染色范围较大便于寻找,3种染料的SLN检出率无差别,3种染料各具优缺点,效果相仿。

Objective To observe dynamically the running feature of three reactive dyes which were widely applied abroad and in our country:1% isosulfan blue(IB), 1% patent blue(PB) and 1% methylene blue(MB) from the second mammal to axillary lymph system, and provide experimental evidence for the choice of ideal dye for the sentinel lymph node biopsy(SLNB) in breast cancer. Methods Thirty female adult rabbits were randomly divided into three groups with 10 rabbits in each group. The first group of axillary lymph nodes which the vital dyes arrived from the lymph tubes were named the sentinel lymph nodes(SLN). After anesthesia and the axillary lymph nodes draining the lymph from the second mammal were exposed, the female rabbits were used to observe the dying time of the sentinel and the second lymph nodes, the number of the dying nodes, and the fading time of the dying lymph nodes after the second mammal was injected different vital blue dyes 0.1 ml. Results The average time from the vital blue injection of the second mammal in rabbits to sentinel lymph nodes being stained was 20.6, 16.8,14.7 seconds (P=0.040) by using IB, PB and MB respectively. Observed by naked eyes, the lymph nodes were stained most deeply by MB, secondly by IB, most lightly by PB. The average times from the injection to second lymph nodes stained by IB,PB,MB were 45.8,40.6,23.5 seconds, there was no obvious difference between the first two ones(P=0.257),but the last one was distinctly different with the two ones(P=0.000).The average start and complete fading time of the lymph nodes stained by patent blue and isosulfan blue were 6.384±0.944, 33.9±2.8 and 2.3±3.3, 64.2±2.4 minutes, the lymph nodes were still stained deeply after stained by the methylene blue(P=0.000).Conclusion The dying time from the second mammal to the sentinel lymph nodes of the group of MB is shortest, the lymph nodes were stained by MB deeply and the lasting time is longest. The staying time of IB and PB in the sentinel lymph nodes are longer , the staining scope are wide to be convenient to look for the stained lymph nodes, the detection rate of three dyes had no difference.