前哨淋巴结活检术在肢体黑色素瘤治疗中的作用和意义

Role and significance of sentinel lymph node biopsy for the treatment of melanoma of the extremities

目的评价前哨淋巴结活检术在肢体黑色素瘤治疗中的作用和意义。方法回顾性分析2007年4月至2013年8月收治的48例肢体黑色素瘤患者的临床资料。48例患者均采用前哨淋巴结活检＋手术治疗的方法。其中截指（趾）术11例，保肢术37例。采用游离植皮或转移皮瓣修复重建28例。广泛切除37例，根治性切除11例。Ⅰ、Ⅱ期39例，Ⅲ期9例。术后化疗患者9例，行白介素＋干扰素治疗者26例。全组46例患者获得随访，2例失访，随访率为95．8％。随访时间2—60个月，平均随访时间为20．1个月。结果在行前哨淋巴结活检阴性的39例患者中，4例发生复发或转移。而在9例前哨淋巴结活检阳性且行淋巴结清扫的患者中，3例复发。前哨淋巴结活检阴性者的术后中位无瘤生存时间为19．5个月，明显优于活检阳性者（9．5个月，P=0．030）。而患者的性别和年龄与术后无瘤生存时间均无关（均P〉0．05）。结论前哨淋巴结活检术通过放射性示踪剂的淋巴显像可以更好地掌握黑色素瘤区域淋巴结转移的情况，进而明确病理分期、指导治疗方案和评价预后。

Objective To evaluate the role of sentinel lymph node biopsy （SLNB） for the treatment of melanoma of the extremities. Methods From April 2007 to August 2013, forty-eight （25 men and 23 women） cases of melanoma of the extremities underwent sentinel lymph node biopsy. All the cases had sentinel lymph node biopsy and surgery. Among them 37 cases underwent limb salvage surgery, while 11 cases underwent amputation. Of the cases with limb salvage, 28 cases underwent free skin grafting or local flap grafting reconstruction after wide resection. Of the surgical margin, wide resection was performed in 37 patients, and radical resection was performed in 11 cases. There were 39 cases in stage Ⅰ or Ⅱ , and 9 cases in stage Ill. After the surgery, adjuvant chemotherapy was performed in 9 cases, and adjuvant biotherapy of interferon and interleukin was performed in 26 cases. Except for 2 cases, 46 cases were followed up with a mean follow-up period of 20. 1 months （ range from 2 to 60 months ）. Results 39 （81.3%） cases had negative SLNB, while 9 （ 18.8% ） cases had positive SLNB. Recurrence or metastasis was more common in those with positive SLNB （3 of 9 cases, 33.3% ） compared with those with negative SLNB （4 of 39 cases, 10.3% ）. The median disease-free survival of patients with negative results was 19.5 months, significantly longer than that of the positive cases （9.5 months, P = 0. 03）. Otherwise, sex and age showed no significant difference in the disease free survivals. Conclusions Sentinel lymph node biopsy enables us to have a better understanding of regional lymph node status through lymphoscintigraphy. It improves the accuracy of staging and provides valuable prognostic information to guide subsequent treatment decisions.