Intraoperative Lymphatic Mapping and Sentinel Lymph Node Identification with Methylene Blue Dye in Endometrial Cancer
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摘要: 目的 :探讨在子宫内膜癌淋巴结切除术中进行前哨淋巴结(SLN)识别的可行性。 方法 :选择接受手术治疗的临床Ⅰ、Ⅱ期子宫内膜癌患者31例。术中将示踪剂亚甲蓝分多点注射于子宫浆膜下,进而追踪识别蓝染的淋巴结为SLN。切取SLN后再行其它淋巴结切除,SLN与其它淋巴结分送常规病理检查。 结果 :31例中4例(12.9%)在注射亚甲蓝过程中发生泄漏,无淋巴管着色。其余27例(87.1%)均有子宫浆膜面及双侧骨盆漏斗韧带内的淋巴管着色,其中22例盆腔内淋巴管同时着色。27例淋巴管着色的病例中23例(85.2%)识别出SLN,共计90枚,平均每例3.9枚(1～10枚)。除1枚(1.1%)SLN位于腹主动脉旁区域外,其余89枚(98.9%)分布于盆腔的各组淋巴结中,主要为闭孔38枚(42.2%)、髂内19枚(21.1%)。本组中27例(87.1%)患者接受了盆腔淋巴结清扫术,4例(12.9%)行盆腔淋巴结取样术。31例中7例(22.6%)同期行腹主动脉旁淋巴结取样术。手术共切除淋巴结926枚,平均每例29.8枚(14～55枚)。3例(9.7%)患者发生淋巴结转移,其中2例SLN转移,另1例转移患者无SLN检出。未发现与本研究相关的损伤及不良反应。 结论 :应用亚甲蓝在子宫内膜癌术中进行SLN识别具有可行性,此技术简便、安全,值得进一步探讨。
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关键词:
- 子宫肿瘤 /
- 淋巴结转移 /
- 前哨淋巴结活组织检查 /
- 淋巴结切除术
Abstract: Objective : To evaluate the feasibility of intraoperative detection of sentinel lymph nodes (SLN) in patients with endometrial cancer. Methods : Thirty-one patients with clinical stage I-II endometrial cancer treated with hysterectomy and lymph node excision were enrolled in the study.At laparotomy, methylene blue dye was in-jected into the subserosal myometrium of corpus uteri at multiple sites.Dye uptake into lymphatic channels was observed and blue nodes identified as SLNs were excised.Other nodes were also removed.All resected nodes were submitted to pathology after hematoxylin and eosin (H&E) staining. Results : Dye uptake failed in 4 (12.9%) cases because of spillage.Blue dye diffusing to the lymphatic channels in the uterine surface and infundibulopelvic ligaments was seen in the remaining 27 (87.1%) cases.Among those cases, blue dye taken up into pelvic lymphatic vessels was observed in 22 patients.The SLNs were identified in 23 of the 27 (85.2%) cases.A total of 90 SLNs with a mean number of 3.9 SLNs (range, 1-10) for each patient were identi-fied.One SLN was found in the paraaortic area, and the other 89 SLNs (98.9%) were in the pelvis.The most frequent locations of SLNs included obturator in 38 patients (42.2%) and interiliac lymph nodes in 19 patients (21.1%).Twenty seven (87.1%) patients received pelvic lymphadenectomy and 4 received pelvic node sam-pling.Of the 31 cases, 7 received paraaortic node sampling.A total of 926 nodes with a mean number of 39.8 nodes (range: 14-55) for each patient were harvested.Three patients (9.7%) had nodal metastases, 2 of them had involvement with at least 1 SLN, and one patient had no SLN.No adverse reactions or injuries were at-tributed to the study. Conclusion : Intraoperative SLN identification with methylene blue dye in endometrial can-cer is feasible and safe. -
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[1] 1 Creasman WT, Morrow CP, Bundy BN, et al.Surgical patholog-ic spread patterns of endometrial cancer.A Gynecologic Oncolo-gy Group Study[J].Cancer, 1987, 60 (8 Suppl): 2035-2041.
2 Cabanas RM.An approach for the treatment of penile carcinoma [J].Cancer, 1977, 39(2): 456-466.
3 李斌,吴令英,李晓光,等.早期子宫颈癌宫旁淋巴结的识别及其 临床意义[J].中华妇产科杂志, 2006, 41(9):608-611.
4 Burke TW, Levenback C, Tornos C, et al.Intra abdominal lym-phatic mapping to direct selective pelvic and paraaortic lym-phadenectomy in women with high-risk endometrial cancer: re-sult of a pilot study[J].Gynecol Oncol, 1996, 62(2):169-173.
5 Barranger E, Cortez A, Grahek D, et al.Laparoscopic sentinel node procedure using a combination of patent blue and radiocol-loid in women with endometrial cancer[J].Ann Surg Oncol, 2004, 11(3): 344-349.
6 Raspagliesi F, Ditto A, Kusamura S, et al.Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a fea-sibility study[J].Am J Obstet Gynecol, 2004, 191(2): 435-439.
7 Holub Z, Jabor A, Lukac J, et al.Laparoscopic detection of sen-tinel lymph nodes using blue dye in women with cervical and en-dometrial cancer[J].Med Sci Monit, 2004, 10(10): CR587-CR591.
8 Maccauro M, Lucignani G, Aliberti G, et al.Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer[J].Eur J Nucl Med Mol Imaging, 2005, 32(5): 569-574.
9 Altgassen C, Pagenstecher J, Hornung D, et al.A new approach to label sentinel nodes in endometrial cancer[J].Gynecol Oncol, 2007, 105(2): 457-461.
10 Lopes LA, Nicolau SM, Baracat FF, et al.Sentinel lymph node in endometrial cancer[J].Int J Gynecol Cancer, 2007, 17(5): 1113-1117.
11 Frumovitz M, Bodurka DC, Broaddus RR, et al.Lymphatic map-ping and sentinel node biopsy in women with high-risk endome-trial cancer[J].Gynecol Oncol, 2007, 104(1): 100-103.
12 Thevarajah S, Huston TL, Simmons RM, et al.A comparison of the adverse reactions associated with isosulfan blue versus methylene blue dye in sentinel lymph node biopsy for breast can-cer[J].Am J Surg, 2005, 189(2): 236-239.
13 Jobo T, Sato R, Arai T, et al.Lymph node pathway in the spread of endometrial carcinoma[J].Eur J Gynaecol Oncol, 2005, 26(2): 167-169.
14 Mariani A, Webb MJ, Keeney GL, et al.Routes of lymphatic spread: a study of 112 consecutive patients with endometrial can-cer[J].Gynecol Oncol, 2001, 81(1): 100-104.
15 Duncan M, Cech A, Wechter D, et al.Criteria for establishing the adequacy of a sentinel lymphadenectomy[J].Am J Surg, 2004, 187: 639-642.
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