不同示踪剂在早期宫颈癌前哨淋巴结定位中的临床应用

Clinical Application of Different Tracers in Early Cervical Cancer Sentinel Lymph Node Localization

目的对比分析纳米炭与亚甲蓝在早期宫颈癌前哨淋巴结定位中的应用效果,为临床示踪剂选择提供参考。方法选择确诊为早期宫颈癌的60例患者作为研究对象,采用数字随机表法分为纳米炭示踪组和亚甲蓝示踪组,每组30例。两组患者均于手术同期行前哨淋巴结活检,纳米炭示踪组患者采用纳米炭作为示踪剂,亚甲蓝组采用亚甲蓝作为示踪剂,两组患者均行腹腔镜或开腹手术,术中切除探查前哨淋巴结,亚甲蓝组患者蓝染淋巴结为前哨淋巴结,纳米炭组患者以黑染淋巴结为前哨淋巴结,均予以切除。术中行广泛切除全子宫及淋巴结清扫术,同时于腹主动脉旁取样淋巴结,术中均采用快速冰冻切片法和组织免疫法对前哨淋巴结、清扫的所有淋巴结及腹主动脉旁淋巴结进行病理检测。结果 30例亚甲蓝示踪组患者中切除淋巴结254个,共检出前哨淋巴结38个,SLN肿瘤转移2枚,病理检查肿瘤转移5枚;纳米炭示踪组患者切除淋巴结261个,前哨淋巴结检出44个,SLN肿瘤转移4枚,病理检测肿瘤转移4例。纳米炭示踪组前哨淋巴结检出率明显高于亚甲蓝示踪组(P<0.05),两组患者的定位分布构成比比较差异无统计学意义(P>0.05)。亚甲蓝示踪组检出前哨淋巴结转移的敏感性为33.3%、准确性为80.0%、特异性为87.5%。纳米炭示踪组检出前哨淋巴结转移的敏感性为80.0%、准确性为86.7%、特异性为88.0%。结论纳米炭宫颈注射进行宫颈恶性肿瘤前哨淋巴结的检测技术优于亚甲蓝,是临床可行的,但还需要大量的临床研究进一步证实。

Objective To compare the effect of carbon nanoparticles and methylene blue in early cervical cancer sentinel lymph node localization, and provide reference for selection of clinical tracers. Methods 60 early cervical cancer were selected as research subjects,which were randomly assigned into nano-carbon tracer group and methylene blue group, each with 30 cases. All patients received the surgical sentinel lymph node biopsy in the same period, the nano-carbon tracing patients using nano-carbon as a tracer, methylene blue group using methylene blue as a tracer, both groups underwent laparoscopy or laparotomy, sentinel lymph node resected exploration, methylene blue group blue stained lymph nodes as sentinel lymph node, the nano-carbon group black stained lymph nodes as sentinel lymph nodes, both were removed. Intraoperative wide excision hysterectomy and lymph node dissection were conducted ,while in para-aortic lymph node samphng, used intraoperative frozen section method and immunohisto- chemical method for sentinel lymph nodes, all the lymph nodes and lymph node dissection aortic pathology testing, comparison of the 2 groups of patients tracer in detection of sentinel lymph nodes and different pathological test resuhs. Results 30 cases of methylene blue patients resected 254 lymph nodes,were found 38 sentinel lymph nodes,2 SLN metastasis, pathological examina- tion of 5 tumor metastasis; nano-carbon tracing 261 patients resected lymph nodes,44 sentinel lymph nodes,4 SLN metastasis, pathological examination of tumor metastasis in 4 cases. Nano-carbon tracing group of sentinel lymph node detection rate was significantly higher than that of methylene blue tracer group （ P 〈 0.05 ）, positioning the 2 groups of distribution had no significant difference（P 〉0.05）. Methylene blue sentinel lymph node metastasis group detection sensitivity was 33.3% and accuracy was 80.0%, specificity was 87.5%. Nano-earbon tracer group sentinel lymph node metastasis detection sensitivity was 80.0%, accuracy was 86.7%, specificity was 88.0%. Conclusion Carbon nanoparticles injection cervix cervical cancer sentinel lymph node detection technique is superior to methylene blue, it is clinically feasible, but it requires a lot of clinical studies further confirmed