早期子宫恶性肿瘤术中盆腔淋巴结双显影技术的应用探索

Development of a Dual Visualization Technique for Pelvic Lymph Nodes Mapping During Surgery for Early Stage Uterine Malignancies

目的 采用盆腔淋巴结双显影技术探讨下肢回流淋巴结与子宫回流前哨淋巴结的关系。方法 选择2022年3~12月22例早期子宫颈癌或子宫内膜癌,双足第一蹼间注射吲哚菁绿显影下肢回流的淋巴结,宫颈注射纳米碳显影子宫回流的前哨淋巴结,观察术中2个来源的盆腔淋巴结分布,记录不良反应及术后并发症。结果 吲哚菁绿盆腔淋巴结显影率100%(22/22),纳米碳前哨淋巴结显影率90.9%(20/22)。前哨淋巴结分布于闭孔淋巴结(8/22)和髂外血管内侧淋巴结(12/22),其中62.5%(5/8)闭孔前哨淋巴结呈现吲哚菁绿与纳米碳双显影。吲哚菁绿显影下肢回流的盆腹腔淋巴结分布于髂外末端淋巴结、髂外淋巴结、闭孔淋巴结、髂总-腹主动脉旁淋巴结。均未出现不良反应,短期随访中仅1例行系统性盆腔淋巴结切除者出现盆腔淋巴囊肿。结论 盆腔淋巴结双显影技术观察到下肢和子宫来源淋巴结的分布规律,在闭孔淋巴结二者均显影较多。

Objective To investigate the relationship between lower extremity reflux lymph nodes and uterine reflux sentinel lymph nodes by using pelvic lymph node dual visualization technique.Methods A total of 22 patients with early-stage cervical or endometrial cancer from March to December 2022 were enrolled.The indocyanine green was injected between the first webbed feet to visualize the lymph nodes of lower extremity reflux,and nanocarbon was injected into the cervix to visualize the sentinel lymph nodes of uterine reflux.The distribution of pelvic lymph nodes from two sources was observed during operation,and adverse reactions and postoperative complications were recorded.Results The visualization rate of indocyanine green pelvic lymph nodes was 100%(22/22),and the visualization rate of the nanocarbon sentinel lymph nodes was 90.9%(20/22).The sentinel lymph nodes were distributed in the obturator lymph nodes(8/22)and the external iliac vascular medial lymph nodes(12/22),of which 62.5%(5/8)of the obturator sentinel lymph nodes presented dual visualization of indocyanine green and nanocarbon.The pelvic and abdominal lymph nodes of lower extremity reflux with indocyanine green imaging were distributed in the distal external iliac lymph nodes,external iliac lymph nodes,obturator lymph nodes,and common iliac-paraaortic lymph nodes.No adverse effects were observed in all the patients,and only 1 patient undergoing systemic pelvic lymphadenectomy developed pelvic lymph cyst during short-term follow-ups.Conclusions The distribution of lymph nodes derived from the lower limbs and uterus is obtained by pelvic lymph node dual visualization technique.Both mappings are more common in the obturator lymph nodes.