吲哚菁绿荧光指引腹腔镜淋巴结切除在临床早期子宫颈癌分期手术中的应用研究  

Study on the Application of Indocyanine Green Fluorescence Guided Laparoscopic Lymph Node Resection in Clinical Early Stage Cervical Cancer Staging Surgery

作　　者：汤彪 任肖艳 伍玲 常军 余绍兰 吴文娟 李秋樊 王刚 TANG Biao;REN Xiaoyan;WU Ling(Department of Gynecology,Sichuan Provincial Maternity and Child Health Care Hospital,Sichuan Provincial Hospital for Women and Children,Affiliated Women and Children′s Hospital of Chengdu Medical College,Chengdu Sichuan 610043,China)

机构地区：[1]四川省妇幼保健院·四川省妇女儿童医院·成都医学院附属妇女儿童医院妇科,四川成都610043 [2]四川省妇幼保健院·四川省妇女儿童医院·成都医学院附属妇女儿童医院病理科,四川成都610043

出　　处：《实用妇产科杂志》2024年第9期734-738,共5页Journal of Practical Obstetrics and Gynecology

基　　金：四川省科技计划项目(编号:22ZDYF1195);四川省医学会项目(编号:S20015)。

摘　　要：目的:探讨吲哚菁绿(ICG)淋巴示踪在临床早期子宫颈癌分期手术中的可行性和应用价值。方法:回顾性分析2022年4月1日至2023年7月31日于四川省妇幼保健院接受腹腔镜下广泛子宫切除+盆腔淋巴结切除+低位腹主动脉旁淋巴结取样的临床早期(ⅠA1~ⅡA1期)子宫颈癌31例患者的临床资料,按是否注射ICG分为ICG指引的淋巴结切除组(ICG组,17例)和常规手术组(对照组,14例)。将切除的淋巴结按部位及是否显影分类送检,采用列联系数法分析淋巴显影模式与淋巴结转移及临床病理的相关性,并比较两组的围术期相关资料。结果:①8例(25.8%)患者(两组各4例)术后分期较术前临床分期提升。ICG组切除淋巴结数少于对照组(18±9枚/人vs.26±11枚/人,P<0.05)。两组手术时间、术中出血量及术后FIGO(2018)分期、淋巴结转移率、切除淋巴结阳性率比较,差异均无统计学意义(P>0.05)。②ICG组中ICG显影率为64.71%(11/17),显影淋巴结阳性率与非显影淋巴结阳性率比较,差异无统计学意义(P>0.05)。显影区域与淋巴结转移间有显著相关性(C=0.707,P<0.05),同一患者淋巴结是否显影与淋巴结转移间有显著相关性(C=0.557,P<0.05)。结论:临床早期子宫颈癌淋巴结转移率低,ICG荧光显影可以示踪淋巴结并预测转移风险,在ICG示踪技术指引下仅切除显影淋巴结,即可充分评估早期子宫颈癌淋巴结转移状态,值得进一步深入研究。Objective:To explore the feasibility and application value of indocyanine green(ICG)lymph node tracer in clinical early stage cervical cancer staging surgery.Methods:A retrospective analysis was performed on 31 patients with early clinical stage(ⅠA1-ⅡA1)cervical cancer who underwent laparoscopic radical hysterectomy,pelvic lymph node resection and para-aortic lymph node sampling were selected as the study subjects in Sichuan Provincial Maternal and Child Health Care Hospital from April 1,2022 to July 31,2023.They were divided into the ICG fluorescence tracer group(ICG group,17 cases)and the conventional surgery group(control group,14 cases)based on whether ICG was injected or not.The resected lymph nodes were classified and submitted for examination according to location and whether they presented visualization.The method of contingency coefficient was used to analyze the correlations between lymph node visualization patterns and lymph node metastasis and clinicopathological characteristics,and the perioperative data of the two groups were compared.Results:①The postoperative stage of 8 patients(25.8%)(4 in each group)were improved compared with the preoperative clini-cal stage.The number of resected lymph nodes in the ICG group was less than that in the control group(18±9 nodes/person vs.26±11 nodes/person,P<0.05).There were no statistically significant differences in operation time,intraoperative blood loss,postoperative FIGO(2018)staging,lymph node metastasis rate,and positive rate of resected lymph nodes between the two groups(P>0.05).②The visualization rate in the ICG group was 64.71%(11/17).There was no statistically significant difference in the positive rate between the visualized and non-visualized lymph nodes(P>0.05).There was a significant correlation between lymph node visualization and lymph node metastasis(C=0.707,P<0.05),and a significant correlation was found between lymph node visualization and lymph node metastasis in the same patient(C=0.557,P<0.05).Conclusions:The rate of lymph node m

关 键 词：吲哚菁绿 淋巴示踪 子宫颈癌 手术病理分期 腹腔镜手术 

分 类 号：R737.33[医药卫生—肿瘤]