前哨淋巴结绘图在子宫内膜癌腹腔镜手术中的应用

Application of Sentinel Lymph Node Mapping in Laparoscopic Operation of Uterine Endometrial Carcinoma

目的探讨前哨淋巴结绘图在腹腔镜子宫内膜癌手术中的应用价值。方法 59例子宫内膜癌患者均采用腹腔镜下全子宫(或广泛全子宫)+双附件切除+盆腔淋巴结清扫术,术中在腹腔镜监视下将亚甲蓝染剂注射在子宫体四周的浆膜下层,观察并记录蓝染的前哨淋巴结部位、数量。术中所有淋巴结经苏木精-伊红染色病理学检查。结果腹腔镜下前哨淋巴结检出率为11.9%(7/59)、灵敏度为87.5%(7/8)、特异度为100.0%(51/51)、准确性为98.3%(58/59)、阴性预测值为98.1%(51/52)。分析前哨淋巴结与盆腔淋巴结转移状态的一致性,得到Kappa系数为0.924,P<0.001。结论前哨淋巴结绘图具有灵敏度高、特异性好、操作简便,可作为腹腔镜子宫内膜癌手术中预测盆腔淋巴结整体转移情况的常规方法。

Objective To investigate the value of sentinel lymph node mapping of laparoscopic operation in endometrial carcinoma. Methods 59 cases of endometrial carcinoma were treated by laparoscopic total hysterectomy（ or extensive total hysterectomy） ＋ oophorectomy and bilateral pelvic lymph node dissection. The methylene blue dye was injected in the body of uterine around the subserosa under laparoscopic operation supervision. The number of sentinel lymph node and locations were observed and recorded. Results Laparoscopic sentinel lymph node detection rate was 11. 9%（ 7 /59）,the sensitivity was 87. 5%（ 7 /8）,the specificity was 100%（ 51 /51）,the accuracy was 98. 3%（ 58 /59）,the negative predictive value was 98. 1%（ 51 /52）. The coefficient of Kappa was 0. 924（ P〈0. 001） through the analysis of the consistency of the sentinel lymph node with metastasis of pelvic lymph node status. Conclusions Sentinel lymph node mapping with high sensitivity and specificity,simple operation,can be used as conventional method of laparoscopic surgery for endometrial carcinoma predicting the overall situation of pelvic lymph node metastasis.