前哨淋巴结成像在子宫内膜癌中的应用

Application of Sentinel Lymph Node Imaging in Endometrial Cancer

目的探讨分析亚甲蓝示踪前哨淋巴结(SLN)成像在子宫内膜癌手术中寻找前哨淋巴结的临床应用价值。方法选取2016年3月至2017年3月齐齐哈尔市第一医院妇产科收治的45例子宫内膜癌患者。术前于宫颈3、6、9、12点钟位置注射亚甲蓝,术中识别并记录蓝染SLN的部位、数量,随后采用腹式或腹腔镜行(广泛)全子宫+双附件切除+盆腔±腹主动脉旁淋巴结清扫术,术后所有淋巴结经苏木精-伊红染色及免疫组化病理分析。结果总体及双侧盆腔SLN检出率分别为13.3%及8.9%,灵敏85.7%,假阴性率14.3%。结论亚甲蓝示踪SLN成像对于子宫内膜癌淋巴结转移有较高的诊断准确性,在内膜癌分期手术中可以安全地替代系统性的淋巴结切除。

Objective To evaluate the clinical value of methylene blue(MB)tracing sentinel lymph node(SLN)imaging in finding sentinel lymph nodes in endometrial cancer surgery.Methods From March 2016 to March 201745 patients with endometrial cancer were injected methylene blue at 3,6,9 and 12 o'clock before operation.The location and number of blue-stained SLN were identified and recorded during operation.Then,abdominal or laparoscopic hysterectomy with double appendages and pelvic(para-abdominal aortic)lymphadenectomy were performed.All lymph nodes were stained with hematoxylin-eosin and immunohistochemical analysi.Results The overall and bilateral pelvic SLN detection rates were 13.3%and 8.9%,respectively.The sensitivity was 85.7%,and the false negative rate was 14.3%.Conclusion SLN imaging with methylene blue tracer has high diagnostic accuracy for lymph node metastasis of endometrial cancer,and can safely replace systematic lymph node resection in staging operation of endometrial cancer.