前哨淋巴结活检在外阴恶性黑色素瘤治疗中的初步研究

Role of Sentinel Lymph Node Biopsy in the Management of Vulvar Melanoma

目的：初步探讨前哨淋巴结（SLN）在外阴恶性黑色素瘤治疗中的临床应用可行性。方法：3例外阴恶性黑色素瘤患者接受根治性外阴切除术＋双腹股沟淋巴结清扫术，术前在肿瘤周围皮下粘膜注射1％亚甲蓝溶液1．5ml。术中先行SLN活检术（SLNB），根据染料指示在腹股沟术野内对淋巴结组织进行精细解剖，分离出蓝染的淋巴结为SLN，SLN与清扫术中的非前哨淋巴结（NSLN）分别送栓，通过HE染色常规病理检查对病理结果进行比较。结果：3例患者均有SLN检出，分别为1、5、3枚。清扫手术切除NSLN分别为19、32、16枚。3例中1例出现淋巴结转移，为l枚SLN转移；其余2例无淋巴结转移发生。没有假阴性情况出现，无与本研究相关的损伤及副反应发生。结论：SLNB应用于外阴恶性黑色素瘤具有可行性。

Objective： To investigate the feasibility of utilizing sentinel lymph node biopsy （SLNB） in the management of vulvar melanoma. Methods： Three patients with vulvar melanoma underwent traditional radical vulvectomy and bilateral inguinal lymphadenectomy. Before surgery, 1.5 ml methylene blue dye was intradermally injected around the primary tumor. SLNB was done before lymphadenectomy. Stained nodes were carefully dissected as SLN in the inguinal area. These nodes were excised and sent for pathological examination and were compared with NSLN. Results： SLN were identified in all three patients. There were 1, 5, and 3 SLN for each patient in SLNB, and 19, 32, and 16 NSLN in lymphadenectomy. One patient had a positive lymph node, which was also identified as a SLN. The other two patients had no lymphatic metastasis. No patient had false-negative SLNs. No damage or adverse reactions were found after the procedure. Conclusion： SLNB is feasible in the management of vulvar melanoma.