前哨淋巴结检测在子宫内膜癌精准治疗中的技术研究  

Technical study of sentinel lymph node detection in the precise treatment of endometrial cancer

作　　者：于靓 王劲红[1] 付小萌[1] 杨丹[1] 陈英超[1] 郭静[1] 贾东琪 杜林 姜娟[1] YU Liang;WANG Jin-hong;FU Xiao-meng;YANG Dan;CHEN Ying-chao;GUO Jing;JIA Dong-qi;DU Lin;JIANG Juan(Department of Gynecology,Harbin First Hospital,Harbin Heilongjiang 150000,P.R.China)

机构地区：[1]哈尔滨市第一医院妇一科

出　　处：《中国计划生育和妇产科》2020年第1期69-72,I0003,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨不同部位注射纳米碳示踪剂在子宫内膜癌前哨淋巴结(sentinel lymph node,SLN)检测中的应用价值,探寻子宫内膜癌精准治疗中最优化的SLN示踪技术。方法选取2017年7月至2018年12月于哈尔滨市第一医院接受手术治疗的临床Ⅰ、Ⅱ期子宫内膜癌患者40例,采用随机分组法分为宫底联合宫颈组(20例)和宫腔镜组(20例)。术中分别将纳米碳于宫底联合宫颈、宫腔镜下肿瘤周围子宫内膜多点注射,开腹或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,手术中分别记录染色SLN位置及数目,术后行病理学检查;之后所有患者均规范行子宫、附件切除及系统盆腔淋巴结清扫术或腹主动脉旁淋巴结取样术。比较两种方式用于子宫内膜癌SLN定位的检出率、准确率。结果40例患者SLN检出率为82.5%,占切除淋巴结总数的18.6%。SLN最常位于髂外区(35.7%),然后依次为髂内(32.2%)、髂总(17.5%)、闭孔(9.1%)、腹主动脉旁(4.2%)和宫旁(1.4%)。宫底联合宫颈组SLN术中检出率为90%,宫腔镜组SLN检出率为85%,两组间比较差异无统计学意义(P>0.05)。SLN示踪对子宫内膜癌区域淋巴结转移状况预测的准确率为90%。结论宫底联合宫颈注射法与宫腔镜子宫内膜肿瘤注射法SLN检出率差异无统计学意义;宫底联合宫颈注射法敏感度好且操作简单、学习曲线短,具有较好的临床实用前景。SLN基本可代表区域淋巴结转移状况,SLN示踪检测能明显提高子宫内膜癌手术的淋巴结清扫数量,提高肿瘤淋巴结转移的检出率,同时提高术后病理学分期的准确性。对于指导手术切除范围及指导术后治疗等方面具有重要意义。Objective To explore the application value of carbon nano-tracers injected at different sites in the detection of sentinel lymph node(SLN)in endometrial cancer,and to explore the optimal SLN tracing technology for accurate treatment of endometrial cancer.Methods A total of 40 patients with stageⅠandⅡendometrial cancer who underwent surgical treatment at Harbin First Hospital from July 2017 to December 2018 were selected and randomly divided into the uterine floor combined with cervical group(20 cases)and endoscopic group(20 cases).During the operation,nano-carbon was injected into the uterine floor combined with cervical and endometrium around the tumor under hysteroscopy at multiple points,the first-stage lymph node was observed and resected separately for pathological examination.The position and number of stained SLNs were recorded during surgery,and pathological examinations were performed after operation.After that,all patients underwent hysterectomy,appendectomy,and systematic pelvic lymphadenectomy or abdominal aortic lymph node sampling.The detection rate and accuracy rate of SLN localization for endometrial cancer were compared.Results The detection rate of SLN in 40 patients was 82.5%,accounting for 18.6% of the total number of resected lymph nodes.SLNs were most commonly located in the external iliac region(35.7%),followed by intra-iliac(32.2%),common iliac(17.5%),obturator(9.1%),para-aortic(4.2%)and para-uterine(1.4%).The detection rate of SLN in the uterine floor combined with cervical group was 90%,and the detection rate of SLN in hysteroscopy group was 85%.There was no significant difference between the two groups(P>0.05).SLN tracing accurately predicted 90%of lymph node metastasis in endometrial cancer.Conclusion There was no significant difference in the detection rate of SLN between the uterine floor combined with cervical injection and hysteroscopic endometrial tumor injection.The combination of uterine floor and cervical injection has good sensitivity,simple operation,and short learning cu

关 键 词：纳米碳示踪剂 子宫内膜癌 前哨淋巴结 宫腔镜 宫底联合宫颈 

分 类 号：R737.33[医药卫生—肿瘤]