不同部位注射吲哚菁绿在子宫内膜癌前哨淋巴结定位中的应用

The application of indocyanine green injection at different sites for sentinel lymph node mapping of endometrial cancer

目的探讨不同部位注射吲哚菁绿在子宫内膜癌前哨淋巴结(sentinel lymph node,SLN)检测中的应用价值,探寻子宫内膜癌最优化的SLN示踪技术。方法选取2016年1月至2018年9月于首都医科大学附属北京妇产医院接受手术治疗的临床Ⅰ—Ⅲ期子宫内膜癌患者89例,采用随机数字表法分为宫颈组(35例)和宫腔镜组(54例)。术中分别将吲哚菁绿于宫颈和宫腔镜下多点注射,腹腔镜下观察显影的第一站淋巴结并将其切除单独送病理学检查,之后所有患者均规范行子宫、附件切除及系统盆腔+/-腹主动脉旁淋巴结切除术。比较两种方式用于子宫内膜癌SLN定位的检出率、阴性预测值、敏感度。结果 89例患者SLN检出率为57.3%,占切除淋巴结总数的9.2%。SLN最常位于髂外区(36.6%),然后依次为髂内(23.8%)、髂总(22.1%)、闭孔(9.3%)、腹主动脉旁(5.2%)和宫旁(2.9%)。宫颈组SLN术中检出率为60%,阴性预测值为85.7%,敏感度为50%,宫腔镜组SLN检出率为55.6%,阴性预测值为82.6%,敏感度33.3%,两组间比较差异无显著性(P>0.05)。结论子宫内膜癌患者术中使用吲哚菁绿识别SLN对淋巴结清扫范围有指导意义,宫颈与宫腔两种注射方式均可行,检出率没有明显差异。

Objective To study the application value of indocyanine green(ICG) injection at different sites for sentinel lymph node mapping of patients with endometrial cancer.Method A total of 89 patients with clinical stage Ⅰ—Ⅲ endometrial cancer,who underwent surgery in our hospital from January 2016 to September 2018, were involved in this study.They were randomly divided into two groups, cervical group(35 cases) and hysteroscopic group(54 cases).The ICG was injected into the cervix and hysteroscopy during the operation and the? rst-stage lymph node was observed under laparoscopy. Then the ? rst station lymph node resection is sent to the pathological examination separately. All cases were followed by uterus, accessory resection and system pelvic +/-abdominal aortic lymphadenectomy. Furthermore,the detection rate, negative predictive value, and sensitivity of two methods were compared.Result The detection rate of SLN was 57.3%,accounting for 9.2% of the total number of resected lymph nodes. SLN was most located in the outer area of 36.6%, 23.8% in the sputum,22.1% in the sputum, 9.3% in the closed hole, 5.2% in the abdominal aorta and 2.9% in the uterus. In the cervical group, the detection rate of SLN was 60%, the negative predictive value was 85.7%, and the sensitivity was 50%. The detection rate of SLN in the hysteroscopic group was 55.6%, the negative predictive value was 82.6%, and the sensitivity was 33.3%. There was no signi? cant difference between the two groups(P>0.05). Conclusion In patients with endometrial cancer, the use of ICG to identify SLN has a guiding signi? cance for lymph node dissection. Both cervical and hysteroscopic techniques are feasible, and there is no signi? cant difference in detection rate.