纳米碳标记前哨淋巴结对内生型宫颈癌腹腔淋巴结转移情况的示踪价值研究

The tracer value of nano carbon labeled sentinel lymph nodes for intrabitoneal lymph node metastasis of endogenous cervical cancer

目的探讨纳米碳标记前哨淋巴结(SLN)在内生型宫颈癌腹腔镜手术淋巴结示踪中的价值。方法选取2017年1月—2021年12月在徐州医科大学附属宿迁医院采取腹腔镜手术治疗的200例内生型宫颈癌患者,其中120例术中采用纳米碳示踪技术指导腹腔镜进行腹腔淋巴结清扫(示踪组),80例患者术中未采取纳米碳示踪技术,按照传统解剖路径实施腹腔淋巴结清扫(传统组);比较两组的手术情况指标、清扫淋巴结数目、SLN数目,分析不同病理学特征的宫颈癌患者SLN阳性检出率。结果示踪组患者的平均手术时间短于传统组,平均手术出血量低于传统组,差异有统计学意义(P<0.05);示踪组患者的髂外、闭孔、髂前、宫旁清扫淋巴结数目,以及合计清扫淋巴结数目、SLN数目均大于传统组,差异均有统计学意义(P<0.05);两组患者的髂内、髂总、腹主动脉旁清扫淋巴结数目差异无统计学意义(P>0.05);示踪组患者的并发症发生率为7.50%,与传统组的5.00%差异无统计学意义(P>0.05);国际妇产联盟分期(FIGO)分期为Ⅰ期、肿瘤直径<3.0 cm、非高危人乳头瘤病毒(HPV)感染宫颈癌患者的SLN阳性率高于FIGO分期为Ⅱ期、肿瘤直径≥3.0 cm、高危HPV感染患者,差异均有统计学意义(P<0.05);不同年龄、体质量指数(BMI)、病理学类型的宫颈癌患者SLN检出率比较差异无统计学意义(P>0.05)。结论纳米碳标记SLN在内生型宫颈癌腹腔镜手术中应用有利于缩短手术时间,提高SLN清除率,SLN与肿瘤大小、FIGO分期及高危HPV感染有关。

Objective To investigate the value of nano-carbon labeled sentinel lymph node(SLN)in lymph node tracing during laparoscopic surgery for internal cervical cancer.Methods 200 patients with endogenous cervical cancer who underwent laparoscopic surgery in The Affiliated Suqian Hospital of Xuzhou Medical University Hospital from January 2017 to December 2021 were selected.Among them,120 patients underwent intraoperative abdominal lymph node dissection guided by carbon nanotracer technology(tracer group),and the other 80 patients underwent intraoperative abdominal lymph node dissection according to traditional anatomical path without carbon nanotracer technology(traditional group).The surgical procedure,the number of dissected lymph nodes and the number of SLN were compared between the two groups.The difference of SLN detection rate in cervical cancer patients with different pathological features was analyzed.Results The average operation time of tracer group was shorter than that of traditional group,and the average operation blood loss of tracer group was lower than that of traditional group,with statistical significance(P<0.05).The number of extraliac,obturator,anterior iliac and parastatal lymph nodes dissected in the tracer group was greater than that in the traditional group,and the number of dissected lymph nodes and SLN in the tracer group were greater than that in the traditional group,with statistical significance(P<0.05).There was no significant difference in the number of intrailiac,total iliac and para-aortic dissection lymph nodes in the tracer group compared with the traditional group(P>0.05).The complication rate of tracer group was 7.50%compared with traditional group,with no statistical significance(P>0.05).The SLN positivity rate of cervical cancer patients with FIGO stageⅠ,tumor diameter<3.0 cm,and non high-risk HPV infection was higher than that of patients with FIGO stageⅡ,tumor diameter≥3.0 cm,and high-risk HPV infection,and the differences were statistically significant(P<0.05);There was no significant difference in the detection rate of SLN among cervical cancer patients of different age groups,different BMI and different pathological types(P>0.05).Conclusions The application of nano-carbon labeled SLN in laparoscopic surgery for endogenous cervical cancer is beneficial to shorten the operation time and improve the clearance rate of SLN,which is associated with tumor size,FIGO stage and high-risk HPV infection.