两种示踪剂在子宫内膜癌前哨淋巴结活检中的应用

Application of two tracers in sentinel lymph node biopsy of endometrial cancer

目的:分析亚甲蓝及纳米炭在子宫内膜癌前哨淋巴结活检中的应用价值。方法:将86例子宫内膜癌患者分为亚甲蓝组、纳米炭组两组,每组43例,分别宫颈注射亚甲蓝、纳米炭。活检观察两组淋巴结着色情况,识别、标记并切除最先着色淋巴结作为前哨淋巴结(SLN)。比较两组SLN总检出率、SLN双侧检出率、准确率、阴性预测值及敏感度;分析SLN在子宫内膜癌中总体分布情况。结果:亚甲蓝组、纳米炭组SLN总检出率分别为74.4%、81.4%,差异无统计学意义(P=0.436);两组SLN双侧检出率分别为58.1%、60.5%,差异无统计学意义(P=0.826)。两组检出SLN的准确率、阴性预测值及敏感度差异均无统计学意义(P>0.05);亚甲蓝组前10例及后33例SLN检出率分别为40.0%和84.8%,二者比较差异有统计学意义(P=0.015);纳米炭组前10例及后33例SLN检出率分别为60.0%和87.9%,二者比较差异无统计学意义(P=0.128)。子宫内膜癌SLN主要分布在髂外淋巴结(38.9%)及闭孔淋巴结(35.9%)区域,腹股沟深淋巴结区域(0.7%)最少。结论:亚甲蓝及纳米炭作为示踪剂应用于子宫内膜癌SLN活检中均具有较高临床应用前景;但对于初始手术者而言,纳米炭较亚甲蓝更易于操作、更具有稳定性。

Aim:To analyze the application value of methylene blue and carbon nanoparticle in sentinel lymph node(SLN) biopsy for endometrial cancer.Methods:Eighty-six patients with endometrial cancer were allocated into methylene blue group and carbon nanoparticle group,with 43 in each group.The patients in the 2 groups were injected methylene blue and carbon nanoparticle in cervix,respectively.Observe the coloration of lymph nodes in the 2 groups during operation,identify,label and excise the first colored lymph nodes as SLN.Compare the total detection rate of SLN,the bilateral detection rate of SLN,accuracy rate,negative predictive value and sensitivity for the 2 groups.And analyze the overall distribution of SLN in endometrial cancer.Results:The total detection rate of SLN in methylene blue group and carbon nanoparticle group was 74.4% and 81.4%,respectively,and the difference was not significant(P=0.436);the bilateral detection rate of SLN was 58.1% and 60.5%,respectively,and the difference was not significant(P=0.826).There was no significant differences in the accuracy,negative predictive value,or sensitivity of SLN detection between the 2 groups(P > 0.05).The detection rate of SLN in the first 10 cases and the last 33 cases in methylene blue group was 40.0% and 84.8%,respectively,and there was a significant difference between the 2 groups(P=0.015).The detection rate of SLN in the first10 cases and the last 33 cases in carbon nanoparticle group was 60.0% and 87.9%,respectively,and there was no significant differences between the 2 groups(P=0.128).The SLN of endometrial cancer were mainly distributed in the external iliac and obturator areas(38.9%,35.9%),and the SLN was the least in the deep of groin areas(0.7%).Conclusion:Methylene blue and carbon nanoparticle as tracers have high clinical application prospects in endometrial cancer SLN biopsy,but for initial surgeons,carbon nanoparticle is easier to operate and more stable than methylene blue.