腹腔镜下子宫颈癌前哨淋巴结活检的临床意义

Laparoscopic Sentinel Lymph Node Biopsy in Women with Early Cervical Carcinoma

目的探讨腹腔镜下前哨淋巴结(sentinel lymph node,SLN)活检在早期子宫颈癌治疗中的临床意义。方法回顾性分析2008年2月～2009年4月我院收治的36例行SLN活检的宫颈癌患者的临床资料。术前在宫颈3、6、9、12四点(避开癌灶)注射亚甲蓝各1ml,打开后腹膜观察淋巴结、淋巴管蓝染情况,记录淋巴管的走行和SLN的分布,之后行盆腔淋巴结清扫术。结果SLN检出率83%(30/36),20例术前无放化疗者SLN检出率90%(18/20),16例术前化疗者SLN检出率75%(12/16)。15例检出双侧SLN,15例检出单侧SLN,共有45侧盆腔检出SLN。宫颈癌SLN最常见的部位是闭孔窝78%(35/45)、髂内动脉31%(14/45)和髂外血管27%(12/45)。结论对早期宫颈癌行腹腔镜下SLN活检是安全可行的,SLN活检为子宫颈癌的个体化治疗提供了新的参考指标。

Objective To investigate the feasibility of sentinel lymph node （SLN） biopsy through laparoscopy in patients with early-stage cervical cancer. Methods A retrospective study was conducted on 36 patients with early-stage cervical cancer, who underwent SLN procedure at the First Hospital of Sun Yat-sen University from February 2008 to April 2009. All the patients had 4 ml methylene injected into the cervix subserously. The sentinel nodes were then identified by direct observation of blue dye. ResultsThe total SLN detection rate was 83% （30/36） in cervical cancer. The SLN identification rates were 75% in 16 patients who underwent preoperative neoadjuvant chemotherapy, and 90% in the 20 patients who did not receive adjuvant therapy. Distribution of the SLNs was as follows：the obturator basin in 78% （35/45）, internal iliac area 31% （14/45）, and external iliac area 27% （12/45）. Conclusions Laparoscopic SLN biopsy is a safe, accurate, and feasible procedure for patient with early-stage cervical cancer. It provides new criteria for the individualized management of the disease.