联合示踪法定位前哨淋巴结在早期宫颈癌腹腔镜根治术中的应用价值

Application value of combined tracer localization of sentinel lymph nodes in laparoscopic radical surgery for early cervical cancer

目的探讨早期宫颈癌患者行腹腔镜根治术中采用吲哚菁绿联合亚甲蓝定位前哨淋巴结(SLN)评估淋巴结转移状态的价值。方法抽取2020年1月至2021年1月在三门峡市中心医院治疗的ⅠA2~ⅠB1期宫颈癌患者90例,采用随机数字表法分为对照组和观察组,每组45例。对照组采用亚甲蓝示踪定位SLN,观察组采用吲哚菁绿联合亚甲蓝定位SLN,切除着色淋巴结并进行活检,对比两组患者的SLN检出率、准确率、阴性预测值以及灵敏度,分析SLN在宫颈癌患者盆腔中的分布情况,并对患者进行随访及资料分析。结果对照组切除淋巴结956个,检测SLN 237个,占淋巴结总数的27.69%;观察组切除淋巴结713个,检测SLN 323个,占淋巴结总数的45.30%。观察组SLN检出率(100.00%,45/45)高于对照组(82.22%,37/45),P<0.05;但两组SLN检测准确率、灵敏度及阴性预测值比较差异未见统计学意义(P>0.05)。结论吲哚菁绿联合亚甲蓝是早期宫颈癌患者行盆腔前哨淋巴结活检术的有效示踪法,可在术中准确定位SLN,有效评估盆腔淋巴结转移状态。

Objective To investigate the application value of indocyanine green combined with methylene blue in locating sentinel lymph nodes(SLN)to evaluate lymoh mode metastasis status in laparoscopic radical surgery for early cervical cancer.Methods Ninety patients with stageⅠA2-ⅠB1 cervical cancer treated in Sanmenxia Central Hospital from January 2020 to January 2021 were selected,and they were divided into control group and observation group by random number table method,with 45 cases in each group.Patients in control group used methylene blue to trace SLN,and patients in observation group used indocyanine green combined with methylene blue to locate SLN,and then stained lymph nodes were excised for biopsy.The detection rate,accuracy,negative predictive value and sensitivity of SLN in the two groups were compared,and the distribution of SLN in the pelvic cavity of cervical cancer was analyzed.The patients were followed up,and data were analyzed.Results In control group,956 lymph nodes were removed,and 237 SLN were detected,accounting for 27.69%of the total lymph node.In observation group,713 lymph nodes were removed,and 323 SLN were detected,accounting for 45.30%of the total lymph nodes.The detection rate of SLN in observation group(100.00%,45/45)was higher than that in control group(82.22%,37/45),P<0.05.But there was no significant difference in the detection accuracy,sensitivity and negative predictive value of SLN between the two groups(P>0.05).Conclusions Indocyanine green combined with methylene blue is an effective tracer method for pelvic sentinel lymph node biopsy in patients with early cervical cancer.It can accurately locate SLN and effectively evaluate the status of pelvic lymph node metastasis.