早期宫颈癌前哨淋巴结检测的临床研究

Clinical Study of Sentinel Lymph Nodes Detection in Early Stage Cervical Cancer

[目的]探讨术中用99mTc硫胶体与亚甲蓝联合和单一亚甲蓝两种方法在早期宫颈癌前哨淋巴结(SLN)检测中的临床价值。[方法]2004年8月至2006年12月治疗早期宫颈癌(临床Ⅰb、Ⅱa期)患者61例,分别采用99mTc硫胶体作为示踪剂和亚甲蓝联合定位并切除SLN(Tc99+dye组,27例)和单一亚甲蓝定位并切除SLN(dye组,34例)。然后行盆腔淋巴结清扫术及广泛性子宫切除术。SLN、NSLN分别进行病理检查。[结果]61例患者切除淋巴结共1647枚。48例检测到SLN,共检出SLN141枚,平均每例2.9枚。Tc99+dye组与dye组检出SLN分别为92.5%(25/27)、67.6%(23/34),Tc99+dye联合组显著优于单一dye组(P<0.01)。两组SLN分布依次分别为闭孔(63.2%、61.6%)、髂内(16.2%、19.2%)、髂外(10.3%、11.0%)、宫旁(5.9%、4.1%)和髂总(4.4%、4.1%),两组无显著性差异(P>0.05)。盆腔淋巴结转移共13例(21.3%),共24枚,其中22枚为SLN,2枚为NSLN。1例SLN假阴性。[结论]对早期宫颈癌采用Tc99与亚甲蓝联合比单一亚甲蓝方法具有更高的SLN检出率;SLN主要分布于闭孔、髂内、髂外,但不能忽视宫旁SLN;SLN检测的适应证有待于进一步研究。

[Purpose] To analyse the clinical value of intraoperative sentinel lymph nodes（SLN） detection using Tc99 sulfur colloid labeled tracer combined with methylene blue dye and methylene blue dye alone in early stage cervical cancer. [Methods] From August 2004 to December 2006,SLNs in 61 cases with early stage（ Ⅰ b- Ⅱa） cervical cancer were localized with Te99 labeled tracing combined methylene blue dye （Tc99 plus dye group,27 cases） and methylene blue dye alone （dye group,34 cases）, and were resected. All the patients underwent extensive pelvic lymph nodes dissection and radical hysterectomy. The samples of SLNs and non-SLNs（NSLN） were examined pathologically. [Results] SLNs were identified in 48 of 61 patients. A total of 141 SLNs were identified from 1 647 lymph nodes,with mean 2.9 nodes per patient.SLN identification increased in Tc99 plus dye group（92.5%,25/27） comparing with that in dye alone group （67.6%,23/34）,with significant difference（P〈0.01）. In the 2 groups, SLNs were identified in obturator area （63.2% and 61.6%）, internal iliae area （16.2% and 19.2%）, external iliae area （10.3% and 11.0%）, parametrial area （5.9% and 4.1% ）, common iliac area （4.4% and 4.1%）, with no significant difference （P〉 0.05）. Thirteen（21.3%） patients had pelvic lymph nodes metastasis,with 24 positive lymph nodes, which were 22 SLNs and 2 NSLN.One patient had false-negative SLN in dye group. [Conelusion] Detection of SLN with combination of Tc99 and methylene blue dye has a higher detection rate than that with methylene blue dye alone in early stage cervical cancer. SLNs were scattered in obturator, internal ilica and external iliac, but parametrial cann＇t be overlooked.Indication of SLN detection should be further evaluated.