腹腔镜下子宫内膜癌前哨淋巴结绘图识别技术的初步临床研究

发布时间：2018-03-14 02:06

本文选题：前哨淋巴结　切入点：子宫内膜癌　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究目的是分析子宫内膜癌前哨淋巴结(Sentinel Lymph Node,SLN)的分布、检出率及SLN对腹膜后淋巴结预测的准确性,探讨SLN绘图识别技术在子宫内膜癌治疗中的可行性,为子宫内膜癌患者的精准治疗提供帮助。方法:选取2015年7月1日至2016年12月31日于河北医科大学第四医院收治的66例子宫内膜癌患者,所有患者均于麻醉后手术前5-10分钟采用宫颈3、9点(2点法)或2、5、7、11点(4点法)注射亚甲蓝,先行SLN切除再行腹腔镜下系统性淋巴结切除,对所有切除的淋巴结均行苏木素-伊红(Hematoxylin-eosin,HE)染色的常规病理检测,并对识别的SLN行免疫组化细胞角蛋白(Cytokeratin,CK)微转移病理检测。应用SPSS21.0软件进行统计分析,对检出率、假阴性率、阴性预测值等进行统计描述,计数资料采用χ2检验或Fisher确切概率法,并行一致性Kappa检验。P0.05认为差异有统计学意义。结果:1子宫内膜癌SLN检出率为100%,双侧均检出SLN占97.0%(64/66),仅单侧检出SLN占3.0%(2/66,左侧2例),准确性为100%,假阴性率为0,阴性预测值为100%。2 66例子宫内膜癌患者共切除SLN 427枚,占切除总淋巴结的26.1%(427/1637),平均切除SLN 6.47枚/人,平均切除SLN比NSLN少11.86枚/人。3子宫内膜癌SLN分布为闭孔区占53.2%(227/427),髂外区占23.7%(101/427),髂内区占7.7%(33/427),髂总区占7.5%(32/427),宫旁区占0.5%(2/427),腹股沟深区占0.2%(1/427),腹主动脉旁左侧区占4.4%(19/427),右侧腔静脉旁区占1.9%(8/427),骶前区占0.9%(4/427)。4分析子宫内膜癌SLN与腹膜后淋巴结转移状态一致性,Kappa值为1.000,P0.001。5 66例子宫内膜癌患者中有3例(共5枚)发生淋巴结转移,且均为盆腔SLN转移,非前哨淋巴结(None Sentinel Lymph Node,NSLN)均无转移;其中1枚左髂外SLN经免疫组化CK微转移病理检测证实为微转移,且为微小转移(Micrometastases,MM)。结论:1亚甲蓝是很好的子宫内膜癌SLN绘图的示踪剂,宫颈部位注射示踪剂是显示SLN较好的注射途径,SLN检出率及阴性预测值是评判此技术的关键指标。2子宫内膜癌SLN主要位于闭孔区和髂外区。3在子宫内膜癌患者中行SLN绘图识别技术是安全、可行的。
[Abstract]:Objective: to analyze the distribution, detection rate and accuracy of SLN in the prediction of retroperitoneal lymph nodes in sentinel Lymph Noden of endometrial carcinoma, and to explore the feasibility of SLN mapping in the treatment of endometrial carcinoma. Methods: from July 1st 2015 to December 31st 2016, 66 patients with endometrial carcinoma were treated in 4th Hospital of Hebei Medical University. All patients were given methylene blue (methylene blue) 5 to 10 minutes before operation. SLN resection was performed first and then systemic lymphadenectomy was performed under laparoscope. All lymph nodes resected were detected by routine pathological examination of Hematoxylin-eosin hehe staining and immunohistochemical cytokeratin CK micrometastasis of SLN. The detection rate and false negative rate were analyzed by SPSS21.0 software. The negative predictive value was statistically described, and the count data were analyzed by 蠂 2 test or Fisher exact probability method. Results the positive rate of SLN in endometrial carcinoma of 1: 1 was 100, and that of both sides was 97.00.64 / 660.Only, SLN was detected on one side (3.0 / 66) and on the left (2 / 66). The accuracy was 100, the false negative rate was 0, and the negative predictive rate was 0. A total of 427 SLN were resected from 1002.66 patients with endometrial carcinoma. 26.1% of the total lymph nodes were resected, with an average of 6.47 SLN per person. Resection of SLN 11.86 fewer than NSLN / Human endometrial carcinoma SLN 53.The distribution of SLN in the obturator area was 53.2i / 427, in the external iliac region was 23.7101 / 427, in the internal iliac region was 7.733 / 427, in the total iliac region was 7.532 / 42727, in the para-uterine area was 0.21/ 427m, in the deep inguinal area was 0.21/ 427m, in the left region of the abdominal aorta was 4.4 / 427s, in the right side of vena cava was 19.4 / 427s. The correlation between SLN and retroperitoneal lymph node metastasis status in endometrial carcinoma was 1.000g P 0.001.5 in 3 out of 66 patients with endometrial carcinoma (n = 5). All of them had pelvic SLN metastasis, none Sentinel Lymph NSLNs had no metastasis, and one of the left SLN was confirmed as micrometastases by immunohistochemical CK micrometastasis. Conclusion 1 methylene blue is a good tracer for SLN mapping of endometrial carcinoma. The detection rate and negative predictive value of cervix injection tracer is a good way to display SLN. 2 the SLN of endometrial carcinoma is mainly located in obturator area and external iliac area in endometrial carcinoma patients. 2. 2. SLN is mainly located in obturator area and external iliac area in patients with endometrial carcinoma. SLN drawing recognition technology is safe, Feasible.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

【参考文献】