联合法前哨淋巴通道的临床研究  

Study on sentinel lymphatic channels by using methylene blue and technetium ^(99m)Sulfur colloid in breast cancer patients

作　　者：孙蓉[1] 凌立君[1] 刘晓安[1] 赵佳[1] 耿强[1] 王水[1] 

机构地区：[1]南京医科大学第一附属医院普外科,江苏南京210029

出　　处：《中华肿瘤防治杂志》2007年第17期1328-1330,共3页Chinese Journal of Cancer Prevention and Treatment

基　　金：江苏省卫生厅课题(H9905);江苏省科技发展计划(社会发展)基金资助项目(BS2004040)

摘　　要：目的:通过乳晕下联合注射99mTc-SC和亚甲蓝,研究前哨淋巴通道(SLC)的行走方向、途径、数量及其与前哨淋巴结(SLN)之间的关系,以探讨乳腺癌SLNB出现假阴性的机制,并提出提高其检出率、减少假阴性的方法。方法:93例Ⅰ~Ⅱ期乳腺癌患者行术前核素法SLC显像和术中染料法SLC显像,并据SLC行前哨淋巴结活检(SLNB)。结果:93例中核素法和染料法同时成功显示SLC和SLN者81例。大多数患者只有1条位于乳腺外上象限的SLC,且主要集中在θe角为31°~90°内,均终止于腋窝SLN。沿SLCs解剖出的SLN,病理结果未发现有假阴性和假阳性。结论:尚未发现乳腺癌腋窝"跳跃式"淋巴转移模式,推测SLNB假阴性的产生是技术问题,可能与手术者对SLCs和SLN行走路线和数量的复杂性认识不足有直接关系。核素法与染料法各有优劣,两者联合,优势互补,通过术前核素显像对SLC和SLN的分布获得大致了解后,在术中仔细解剖沿蓝染SLC寻找SLN,可以有效的检出SLC,并减少SLNB的假阴性率。OBJECTIVE, To study the direction, route and num- ber of SLCs and their relationship with SLN after subareolar injection of methylene blue and technetium 99m sulfur colloid （^99m Tc-SC） , and to explore the mechanism of sentinel lymph node biopsies （SLNB） produce false negative results in breast cancer patients and the method to improve the detectable rate, METHODS： ^99m Tc-SC was injected preoperatively, and methylene blue was injected by the same subareo-lar route just after anesthetic induction, and then SLNB was carried out according to SLCs in 93 breast cancer patients （stage I-Ⅱ）. RESULTS： SLCs and SLN were identified by using both methylene blue and ^99m Tc-SC in 81 cases successfully. In most cases, a single SLC exited the areola, traveled through the upper, outer quadrant, mainly at angle θe from 31°to 90° and terminated at an axillary SLN. No false negative or false positive was demonstrated by pathological ananlysis of SLN which was identified according to SLCs. CONCLU-SIONS, No evidence shows that the mechanism of axillary lymph node metastasis is skip metastasis. It is concluded that false negative re-sults from SLNB seems to be associated with the technique used which may be caused by the incomplete knowledge of the anatomical relationship between SLCs and SLN. By combining use of subareolar injection of methylene blue and ^99m Tc-SC, SLCs and SLNs can be i-dentified preoperatively and dissected carefully during operation. The detection rate of SLCs can be improved and the false negative rate of SLNB can be reduced.

关 键 词：乳腺肿瘤 外科学 活组织检查 针吸 淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]