染料法前哨淋巴结识别在宫颈癌中的初探

Blue sentinel lymph node detection in patients with cervical cancer

目的 :探索宫颈癌根治术中识别前哨淋巴结的可行性 ,评价前哨淋巴结预测盆腔淋巴结有无肿瘤转移的准确性。方法 :2 0 0 2年 5月～ 2 0 0 3年 6月 ,2 9例早期宫颈癌在术中于宫颈肿瘤周围注入生物染料 4ml,仔细观察蓝染的淋巴管和淋巴结 10分钟 ,记录蓝染淋巴结的部位和数目。按常规行盆腔淋巴结清扫术 ,根据术后病理计算前哨淋巴结预测盆腔淋巴结转移的准确性和假阴性率。结果 :共有 2 4例在术中找到蓝染的前哨淋巴结 ,识别率为 83% (2 4 / 2 9) ,前哨淋巴结多位于闭孔和髂内 ,分别位于左侧髂内组 11例 ,右侧髂内组 13例 ,左侧闭孔组 10例 ,右侧闭孔组 14例 ,3例分别有髂总和髂内二组蓝染淋巴结。 2 4例成功识别前哨淋巴结的病例中 ,有淋巴结转移 6例 ,其中 5例仅有前哨淋巴结转移 ,1例既有前哨淋巴结转移又有非前哨淋巴结转移 ,18例无前哨淋巴结转移的患者也无盆腔淋巴结转移 ,假阴性率为 0。结论 :宫颈癌根治术中行染料法前哨淋巴结识别是安全可行的 ,前哨淋巴结能准确反映盆腔淋巴结状况。

Purpose:To investigate the feasibility of detecting intraoperatively blue sentinel lymph node (BSLN) in patients with cervical cancer and to evaluate the accuracy of predicting pelvic lymph node disease. Methods:Between May 2002 and Jun 2003,29 patients with cervical cancer FIGO stage Ⅰb ( n =3),stage Ⅱa ( n =21),stage Ⅱb ( n =5) underwent BSLNs detection. During operation 4ml of methlene blue or lymphazurin was injected into the cervical tissue around the tumor or 3′,6′,9′,12′ of normal appearance of cervix about 0.5cm deep. Blue lymph duct and BSLNs were observed and located carefully for 10 minutes. Tumor characteristics,surgical findings,and location and number of BSLNs were recorded and correlated with pathologic results to get the accuracy and false-negative rate.Results:Among 29 patients underwent this technique,BSLNs were seen in 24 patients. Total detection rate was 83%(24/29). Location of BSLNs was mainly in obturator and internal iliac group. BSLNs located in left internal iliac group in 11 patients and 13 patients in right internal iliac group,10 patients in left obturator group,and 14 patients in right obturator group. 3 patients had BSLNs in both iliac and internal iliac group. Among 24 patients with BSLNs,there were 6 patients with lymph node metastases. 5 patients had only SLN metastases and one patient had both SLN and other lymph node disease. 18 patients had neither SLNs nor other pelvic lymph nodes metastases. The false-negative rate was 0.Conclusions:Intraoperatively BSLN detection was feasible and safe. Sentinel lymph node was representative of the lymphatic basin.