子宫早期恶性肿瘤前哨淋巴结绘图的初步报告

发布时间：2018-03-02 21:52

本文选题：子宫早期恶性肿瘤　切入点：腹腔镜手术　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究旨在通过在常见子宫早期恶性肿瘤(宫颈癌和子宫内膜癌)腹腔镜手术中应用吲哚箐绿作为示踪剂行前哨淋巴结绘图,探讨子宫早期恶性肿瘤腹膜后淋巴结切除术中应用前哨淋巴结活检的识别方法及可行性,评价前哨淋巴结预测腹膜后淋巴结有无肿瘤转移的价值。方法选取诊断明确的子宫早期恶性肿瘤21例,其中包括早期宫颈癌13例,子宫内膜癌8例为研究对象。在腹腔镜手术开始前于宫颈3点、9点深部间质注射吲哚箐绿,腹腔镜直视下识别最先出现固定高度荧光信号处淋巴结作为前哨淋巴结(SLN)并切除,送冰冻及常规病理检查。继续行(广泛)全子宫+双侧输卵管/卵巢切除+腹膜后淋巴结切除术±大网膜切除术。记录所有患者切除SLN的显影位置、时间、数目、冰冻及常规病理结果;记录所有腹膜后淋巴结的位置、数目及病理结果。结果1、在21例子宫早期恶性肿瘤患者中,共切除腹膜后淋巴结889枚,平均每例切除42.3枚。2、在21例子宫早期恶性肿瘤患者中,至少成功检测到1枚SLN的有20例,共检出36侧,总检出率为85.7%(36/42)。成功检测到SLN的20例患者中,检出94枚SLN,单侧检出SLN 1-6枚,平均每例患者单侧检出2.6枚SLN。在宫颈癌患者中SLN分布于闭孔淋巴结26枚,占40.1%(26/65);髂外淋巴结21枚,占32.3%(21/65);髂总淋巴结9枚,占13.8%(9/65);髂内淋巴结9枚,占13.8%(9/65)。子宫内膜癌患者中SLN分布于髂外淋巴结13枚,占44.8%(13/29);髂总淋巴结12枚,占41.4%(12/29);髂内淋巴结4枚,占13.8%(4/29)。94枚SLN均于术中送冰冻病理检查,其中2枚SLN阳性,1枚为子宫内膜浆液性腺癌的髂外淋巴结,1枚为宫颈鳞癌的髂总淋巴结。所有前哨淋巴结术中冰冻病理结果与术后常规病理结果一致。3、20例成功检测到SLN的患者中,SLN显影时间为2-19分钟,平均8.9分钟。4、本研究中SLN检测的准确率100.0%(20/20),假阴性率为0,灵敏度为100.0%(2/2),特异度为94.7%(18/19),阳性预测值为100.0%(2/2),阴性预测值为100.0%(18/18)。5、SLN的检出与原发肿瘤大小、肌层浸润深度、病理类型、组织分化程度及脉管癌栓浸润与否等因素无明显相关。结论1、子宫早期恶性肿瘤宫颈注射吲哚菁绿后腹腔镜下前哨淋巴结绘图具有较高的检出率与准确率,是一种较为安全可行的方法。2、宫颈癌的前哨淋巴结常出现在闭孔及髂外淋巴结,子宫内膜癌的前哨淋巴结最常出现在髂外淋巴结,与腹膜后淋巴结真实转移状态具有高度的一致性。前哨淋巴结对于诊断淋巴结转移状态有较高的诊断效能。3、前哨淋巴结的检出与原发肿瘤大小、肌层浸润深度、病理类型、组织分化程度及脉管癌栓浸润与否等因素无明显相关。
[Abstract]:Objective to perform sentinel lymph node mapping by using indocyanine green as a tracer in laparoscopic surgery for common early malignant tumors of the uterus (cervical cancer and endometrial carcinoma). To investigate the identification and feasibility of sentinel lymph node biopsy in retroperitoneal lymphadenectomy for early malignant tumors of uterus. To evaluate the value of sentinel lymph nodes in predicting tumor metastasis in retroperitoneal lymph nodes. Methods 21 cases of early malignant tumors of the uterus were selected, including 13 cases of early cervical cancer. Indocyanine green was injected into the deep stroma of the cervix at 3 o'clock and 9 o'clock before laparoscopic surgery, and the lymph node with fixed high fluorescence signal was first identified as sentinel lymph node (SLN) and resected under the direct vision of laparoscope. Frozen and routine pathological examination. Continue to perform (extensive) hysterectomy of bilateral fallopian tube / ovariectomized retroperitoneal lymphadenectomy 卤omentectomy. Record the location, time, number of SLN excision in all patients. Frozen and routine pathological findings, location, number and pathological results of all retroperitoneal lymph nodes were recorded. Results 1 among 21 patients with early malignant tumors of the uterus, 889 retroperitoneal lymph nodes were resected. In the 21 cases of early uterine malignant tumor, at least one SLN was successfully detected in 20 cases (36 sides), the total detection rate was 85.7% 42%. Among the 20 cases with successful detection of SLN, 94 SLNs were detected, and 1-6 SLN were detected on one side. An average of 2.6 SLNs were detected on one side in each patient. In cervical cancer patients, there were 26 SLN in obturator lymph nodes (40.1%), 21 cases in external iliac lymph nodes (32.3%), 9 cases in common iliac lymph nodes (13.8%), 9 cases in internal iliac lymph nodes, 9 cases in internal iliac lymph nodes. In endometrial carcinoma, 13 were in the external iliac lymph nodes, 13 were in the external iliac lymph nodes, 13 were in the common iliac lymph nodes; 12 were the common iliac lymph nodes, accounting for 41. 4 / 29; 4 were the internal iliac lymph nodes, accounting for 13. 8 / 429. 94 SLN were sent to the frozen pathological examination during the operation. Of them, 2 were SLN positive and 1 was external iliac lymph node with endometrial serous gland carcinoma. One was the common iliac lymph node of cervical squamous cell carcinoma. The intraoperative frozen pathological results of all sentinel lymph nodes were consistent with those of postoperative routine pathology in 20 cases. The imaging time of SLN was 2-19 minutes. In this study, the accuracy of SLN detection was 100.020 / 20, the false negative rate was 0, the sensitivity was 100.02 / 2, the specificity was 94.775 / 19, the positive predictive value was 100.020 / 2, the negative predictive value was 100.010 / 18.5SLN and the primary tumor size, the depth of myometrial invasion, the pathological type. There was no significant correlation between the degree of tissue differentiation and the infiltration of vascular tumor thrombus. Conclusion 1.Laparoscopic sentinel lymph node mapping after indocyanine green injection has a high detection rate and accuracy. The sentinel lymph nodes of cervical cancer often appear in the obturator and the external iliac lymph nodes, and the sentinel lymph nodes of endometrial carcinoma are most often present in the external iliac lymph nodes. Sentinel lymph nodes are highly consistent with the true metastasis of retroperitoneal lymph nodes. The sentinel lymph nodes have high diagnostic efficacy in the diagnosis of lymph node metastasis. The detection of sentinel lymph nodes is associated with the size of primary tumor, the depth of myometrial infiltration, and the pathological types. There was no significant correlation between the degree of tissue differentiation and the invasion of vascular tumor thrombus.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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