不同部位注射纳米炭在腹腔镜子宫内膜癌前哨淋巴结示踪情况的对比研究  

A comparative study of carbon nanoparticles injected at different sites for laparoscopic sentinel lymph node tracing of endometrial carcinoma

作　　者：牛高丽 王虹 孟露红 刘南南 陈静静 赵华[2] 翟艳红 NIU Gaoli;WANG Hong;MENG Luhong;LIU Nannan;CHEN Jingjing;ZHAO Hua;ZHAI Yanhong(Department of Gynecologic Oncology,the First Affiliated Hospital of Henan Polytechnic University,Henan Jiaozuo 454000,China;Department of Obstetrics and Gynecology,Henan Provincial People's Hospital,Henan Zhengzhou 450000,China)

机构地区：[1]河南理工大学第一附属医院妇瘤科,河南焦作454000 [2]河南省人民医院妇产科,河南郑州450000

出　　处：《现代肿瘤医学》2022年第23期4308-4312,共5页Journal of Modern Oncology

基　　金：河南卫健委科技创新杰出青年人才培养项目(编号:YXKC2020021);河南省医学科技攻关计划联合共建项目(编号:LHGJ20210923);河南省焦作市科技局科技计划项目(编号:2020169)。

摘　　要：目的:探讨不同部位注射纳米炭在腹腔镜子宫内膜癌手术前哨淋巴结(sentinel lymph node,SLN)检测中的应用价值,探索最优化的SLN示踪方案。方法:选取2018年03月至2021年06月接受腹腔镜手术的子宫内膜癌患者共76例,随机分为宫颈注射组(39例)及宫底注射组(37例),以纳米炭作为示踪剂多点注射于宫颈或宫底部,在腹腔镜下观察显影的第一站淋巴结并切除后送病理检查,再采取标准的子宫、双附件切除及系统的盆腔淋巴结切除术和/或腹主动脉旁淋巴结切除术。比较两组患者的SLN检出率、检出部位、敏感度、假阴性率、阴性预测值。结果:两组患者总体SLN检出率为81.5%,检出位置:最常见于髂外区21例(33.8%),然后依次为闭孔区16例(25.8%)、髂内区14例(22.6%)、髂总区7例(11.3%)、腹主动脉旁区域3(3.9%)、骶前1例(1.6%)。宫颈注射组在盆腔SLN检出方面更有优势,宫底注射组在腹主动脉旁区域SLN检出方面更有优势。7例(9.2%)发生盆腔淋巴结转移,其中4例在宫颈注射组,敏感度为75%(3/4),假阴性率为25%(1/4),阴性预测值97.1%(34/35)。3例在宫底注射组,敏感度为66.7%(2/3),假阴性率为33.3%(1/3),阴性预测值为96.9%(32/33)。结论:纳米炭应用于腹腔镜子宫内膜癌SLN活检安全高效、操作简便,宫颈注射组更方便,有更好的盆腔SLN检出率,但宫底注射组有更好的腹主动脉旁SLN检出率,值得进一步应用研究。Objective:To investigate the application of carbon nanoparticles injection at different sites for sentinel lymph node(SLN)detection of laparoscopic endometrial cancer and to explore the optimal SLN tracing scheme.Methods:A total of 76 patients with endometrial carcinoma,who underwent laparoscopic surgery in our hospital from March 2018 to June 2021,were randomly divided into the cervical injection group(39 cases)and fundus injection group(37 cases).The nano carbon was injected into the cervix or the bottom of the uterus during the operation and the first-stage lymph nodes was observed under laparoscopy,and after removal of the pathologic examination,standard hysterectomy,bilateral adnexectomy and systematic pelvic+/-abdominal aortic lymphadenectomy were performed.Furthermore,the SLN detection rate,detection site,sensitivity,false negative rate and negative predictive value were compared between the two groups.Results:The overall detection rate of SLN in the two groups was 81.5%,and the detection location was as follows:it was most common in 21 cases(33.8%)in the external iliac region,followed by 16 cases(25.8%)in the obturator region,14 cases(22.6%)in the internal iliac region,7 cases(11.3%)in the general iliac region,3 cases(3.9%)in the para-aortic region,and 1 case(1.6%)in the anterior sacral region.The cervix injection group had more advantages in pelvic SLN detection,and the fundal injection group had more advantages in SLN detection in the para-aortic region.Pelvic lymph node metastasis occurred in 7 patients(9.2%),including 4 in the cervical injection group,with a sensitivity of 75%(3/4),a false negative rate of 25%(1/4),and a negative predictive value of 97.1%(34/35).In 3 cases,the sensitivity was 66.7%(2/3),false negative rate 33.3%(1/3)and negative predictive value 96.9%(32/33)in the fundus injection group.Conclusion:The application of carbon nanoparticles in laparoscopic SLN biopsy of endometrial cancer is safe,efficient and easy to operate.The cervical injection group is more convenient and has a bette

关 键 词：纳米炭 不同部位 前哨淋巴结 子宫内膜癌 

分 类 号：R737.33[医药卫生—肿瘤]