亚甲蓝示踪技术在子宫内膜癌术中寻找前哨淋巴结的临床研究

Clinical study of methylene blue tracer technique in searching for sentinel lymph nodes in endometrial carcinoma

目的研究亚甲蓝示踪技术在子宫内膜癌术中寻找前哨淋巴结(SLN)的临床意义。方法选取本院2015年3月～2017年3月收治的行手术治疗的26例子宫内膜癌患者,按照国际妇产科联盟(FIGO)制定的BOT分期标准患者均为Ⅰ、Ⅱ期病例,遵医嘱将其分为对照组(n=11)和试验组(n=15),对照组行全子宫、盆腔、双附件切除、腹主动脉旁淋巴结清扫术治疗,试验组在上述基础上于术中采用亚甲蓝注射液1 ml作为示踪记,识别记录SLN染色情况,术后全部淋巴结均行病理学检验,比较不同术式的疗效,并以术后病理学检查结果为参照标准,分析SLN阳性检出率。结果试验组术中出血量(173.86±62.69)ml明显小于对照组(238.73±59.34)ml(P<0.05),试验组手术时间(123.06±31.63)min明显长于对照组(161.76±28.74)min(P<0.05);以术后病理学检查结果为金标准,试验组15例接受手术治疗的患者术中SLN阳性检出93.33%,且13例患者存在病灶转移,2例无病灶转移,试验组SLN检测的敏感性、特异性、准确性、漏诊率和误诊率分别为92.30%、50.00%、86.67%、7.69%、50.00%。结论子宫内膜癌术中运用亚甲蓝示踪技术识别前哨淋巴结准确可靠,可为淋巴结清扫实行范围提供重要的参考依据,同时还可有效减少患者术中出血量,具有积极的临床指导意义。

Objective To study the clinical significance of methylene blue tracing technique in finding sentinel lymph node （SLN） in endometrial cancer surgery. Methods From March 2015 to March 2017, Twenty-six patients with endometrial cancer who underwent surgical treatment were divided into two groups according to the BOT staging standard established by FIGO （International Federation of Obstetrics and Gynecology）. The patients were divided into two groups according to the doctor＇s advice （n 11） and the experimental group （n 15）. The control group was treated with total uterine, pelvic, bilateral adnexal excision and abdominal aortic lymph node dissection. On the basis of the above, the experimental group was treated with methylene blue injection 1 ml during the operation.As a tracer, SLN staining was identified and recorded. Pathological examination was performed on all lymph nodes after operation. The curative effects of different surgical methods were compared. The results of pathological examination after operation were used as a reference standard to analyze SLN. Positive detection rate. Results The intraoperative bleeding volume （173.86±62.69） ml in the experimental group was significantly less than that in the control group （238.73±59.34） ml （P〈 0. 05）, and the operation time in the experimental group was （123.06±31.63）min was significantly longer than that of the control group （161.76±28.74） min （P〈0.05）; 15 patients in the experimental group were SLN positive in operation according to the results of pathological examination after operation.The sensitivity, specificity, accuracy, missed diagnosis rate and misdiagnosis rate of SLN detection in the experimental group were 92.30%, 50.00%,86.67%, 7.69%, 50.00% respectively. Conclusion Methylene blue tracer technique is accurate and reliable in identifying sentinel lymph nodes in endometrial cancer surgery, which can provide important reference for the scope of lymph node dissection. According to the data, it can also effectively reduce the amount of blood in the operation, which has positive clinical significance.