亚甲蓝作为前哨淋巴结活检示踪剂的临床和实验研究  

Clinical and experimental study on sentinel lymph node biopsy by using 1% methylene blue

作　　者：张蕾[1] 王水[1] 刘晓安[1] 

机构地区：[1]南京医科大学第一附属医院普外科

出　　处：《南京医科大学学报（自然科学版）》2007年第11期1233-1235,共3页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:通过与1%异硫蓝(1%isosulfan blue,IB)比较,探讨亚甲蓝(methylene blue,MB)作为示踪剂行乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的价值。方法:206例T1、T2乳腺癌患者,随机分为IB组和MB组。分别利用1%IB和MB染色寻找着色的前哨淋巴结(sentinel lymph node,SLN),然后行SLNB,再行乳腺癌改良根治术,全部标本送病理检查。8只雌性成年大耳白家兔随机分IB组和MB组,利用不同染料观察腋窝淋巴结染色的时间、枚数以及退色的时间。结果:206例中,IB组102例检出SLN 94例(92.16%),SLNB的灵敏度为93.94%(31/33),准确率为90.2%(92/102),假阴性率为6.06%(2/33),假阳性率为0。MB组104例检出SLN 97例(93.27%),灵敏度为93.75%(30/32),准确率为91.35%(95/104),假阴性率为6.25%(2/32),假阳性率为0。2组间差异无显著性(P>0.05)。所有患者未发现与IB和MB相关的不良反应。实验部分:注射IB和MB后腋窝淋巴结染色的平均时间分别为8.75 s和13.13 s,前者淋巴结染色的时间明显短于MB组(P=0.000)。IB组可观察到的淋巴结26枚,染色25枚;MB组27枚,染色11枚,IB组染色的淋巴结枚数明显多于MB组(P=0.000)。淋巴结退色时间,IB组55.00 min,MB组108.75 min,IB组淋巴结退色的时间明显快于MB组(P=0.000)。结论:选择MB行乳腺癌SLNB的临床价值与1%IB基本一致,且MB费用低廉,易于购买。MB可以作为IB的替代。Objective：To study sentinel lymph node biopsy （SLNB） in breast cancer patients by using 1% isosulfan blue or methylene blue. Method：206 patients were randomly divided into 2 groups,IB and MB,with injection different dye through peri-nipple and breast parenchyma. All patients undergoing modified radical mastectomy or radical mastectomy with axillary lymph nodes dissection （ALND）, and then the nodes in the ALND specimen were processed for histological examination. 8 female adult rabbits were randomly divided into 2 groups to study the dying time,number and fading time of the sentinel lymph nodes with different dyes. Results：In isosuffan blue group,SLNs were identified in 94 out of 102 patients,with a detection rate of 92.16%. The sensitivity of SLNB in this study was 92.31% ,accuracy was 90.91% ,false negative rate was 6.06% ,false positive rate was 0.In methylene blue group,SLNs were identified in 97 out of 104 cases,with a detection rate of 93.27%. The sensitivity of SLNB in this study was 93.75% ,accuracy was 91.35%, false negative rate was 6.25% ,false positive rate was 0. No statistical significance was shown between isosulfan blue group and methylene blue group（P 〉 0.05）. In the rabbits group,the average staining time of the IB and MB group was 8.75s and 13.13s respectively. There are significant difference of the dying time,number and fading time of the sentinel lymph nodes between two groups（P=0.000）. Conclusion：SLNB using methylene blue possesses the same characteristics of safety and feasibility as using isosulfan blue. Methylene blue is very cheap and can be widely used in the clinic.

关 键 词：异硫蓝 亚甲蓝 前哨淋巴结活检 兔 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤]