前哨淋巴结检测指导早期宫颈癌行经腹广泛性宫颈切除术的临床研究

发布时间：2018-03-20 19:51

本文选题：早期宫颈癌　切入点：前哨淋巴结　出处：《济南大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价前哨淋巴结(sentinel lymph node,SLN)检测结果预测早期(FIGO1A1-1B1期)宫颈癌患者盆腔淋巴结转移状态,并探讨其指导经腹广泛性宫颈切除术(radical abdominal trachelectomy,RAT)的临床意义。方法:回顾2006年1月至2015年6月间在山东大学附属山东省肿瘤医院接受保留生育功能手术治疗的118例FIGO 1A1-1B1期宫颈癌患者作为研究对象,术前在患者宫颈粘膜下注射放射性核素99mTc-硫胶体,术中检测SLN并原位切除,送快速病理检查排除淋巴结转移后,行RAT和盆腔淋巴结清扫,术后将所有淋巴结送检常规病理同时进行抗角蛋白免疫组化检测确定是否存在微转移灶。通过观察SLN检出情况以及RAT的手术时间、出血量、术中及术后并发症、复发率和妊娠率等,评价SLN检测结果对早期(FIGO 1A1-1B1期)宫颈癌患者行RAT手术的临床指导意义。结果:(1)共有114例患者术中检测到SLN,共检出SLN414枚,平均3.6枚/例,检出率为96.7%,其中,SLN双侧检出率为91.2%,单侧检出率为8.8%,SLN检出率与患者的年龄、FIGO分期、肿瘤分化程度及大小无明显相关性(P值分别为0.722,0.944,0.859,0.629);12例患者因术中快速病理检测出SLN转移而转为行广泛性子宫切除术(Radical Hysterectomy,RH),其余106例患者行RAT。(2)术后病理证实盆腔淋巴转移率为11.1%,SLN预测盆腔淋巴结转移状态的灵敏度为92.3%,特异度为100%,阳性预测值为100%,阴性预测值为99%,假阴性率为7.7%,SLN术中快速病理和术后病理的符合率为99.1%。104例双侧盆腔SLN阴性患者术后病理均未发现淋巴结转移。(3)106例患者成功行RAT,中位手术时长为240min(175-280min),中位出血量为400ml(300ml-1000ml)。术中并发症有子宫动脉损伤(2例)、膀胱肌层损伤(1例)术后并发症以残余宫颈管狭窄多见,发生率为18.9%(20/106),其余依次为无感染性盆腔淋巴囊肿9.4%(10/106),下肢水肿5.7%(6/106),停经2.8%(3/106)。(4)106例行RAT患者中完成随访者103例,中位随访时间为90个月。中位无瘤生存期为97个月,复发率为3.8%,死亡率为1.9%,妊娠率30.2%。其中,活产7次(均为剖宫产),自然流产8次(孕3月5次,孕6月1次,孕7月2次),2例患者处于妊娠期。结论:通过放射性核素99mTc-硫胶体进行SLN检测能够准确预测早期宫颈癌患者盆腔淋巴结的转移状态,渴望保留生育功能的1A1-1B1早期宫颈癌患者在SLN检测结果指导下行RAT安全、可行,值得临床推广应用。
[Abstract]:Objective: to evaluate the prediction of pelvic lymph node metastasis in patients with early stage FIGO1A1-1B1 (sentinel lymph nodegna). To explore the clinical significance of guiding radical abdominal trachelectomytomy through abdominal resection of cervix. Methods: from January 2006 to June 2015, 118 cases of FIGO treated by preserving fertility in Shandong Cancer Hospital affiliated to Shandong University were reviewed. Patients with stage 1A1-1B1 cervical cancer were studied. Radionuclide 99mTc- sulfur colloid was injected into the cervical submucous membrane of the patients before operation. SLN was detected and resected in situ during the operation. RAT and pelvic lymph node dissection were performed after rapid pathological examination to exclude lymph node metastasis. After operation, all lymph nodes were sent to routine pathology to determine whether there were micrometastases or not. The detection of SLN, the time of RAT operation, the amount of blood loss, the complications during and after operation were observed. The recurrence rate and pregnancy rate were evaluated. The results of SLN were evaluated for the clinical guidance of RAT surgery in patients with early stage Figo 1A1-1B1) cervical cancer. Results there were 114 cases with SLN414 detected during the operation, with an average of 3.6 cases per case. The detection rate of SLN was 96.7%, the detection rate of SLN was 91.2%, the detection rate of unilateral SLN was 8.8% and the age of the patients was Figo stage. There was no significant correlation between tumor differentiation degree and tumor size (P = 0.72222, 0.944, 0.859, 0.629, respectively) in 12 patients who underwent radical hysterectomy or radical hysterectomy due to rapid pathological examination of SLN metastasis during operation, and the other 106 patients underwent RAT.2.) the pelvic lymphatic transformation was confirmed by pathology after operation. The sensitivity, specificity, positive predictive value, negative predictive value, false negative rate and false negative rate of SLN in predicting pelvic lymph node metastasis were 92.3, 92.3, 100, 100, 99 and 99, respectively. The coincidence rate between rapid pathology and postoperative pathology was 99.1% and 99.1% in 104 patients with bilateral pelvic SLN. No lymph node metastasis was found in all patients. RAT3 was successfully performed in 106 patients. The median operative time was 240min / 175-280 min, and the median bleeding volume was 400ml / 300ml-1000ml / min. The complications included uterine artery injury in 2 cases and bladder muscle layer injury in 1 case. Stricture of the remaining cervical canal was common. The incidence rate was 18.920 / 106, followed by non-infectious pelvic lymphoid cyst 9.410 / 106m, lower extremity edema 5.7cr / 106m. 103 of 106 patients with RAT were followed up (median follow-up time was 90 months), and the median survival time was 97 months (median follow-up time was 90 months) in 106 patients with RAT of 2.8T / 10 / 106.The median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months. The recurrence rate was 3.8, the mortality was 1.9 and the pregnancy rate was 30.2. Among them, there were 7 live births (all caesarean sections), 8 spontaneous abortions (March 5th pregnancy, June 1st pregnancy). Conclusion: SLN detection with 99mTc- sulfur colloid can accurately predict pelvic lymph node metastasis in early cervical cancer patients. 1A1-1B1 early cervical cancer patients eager to retain fertility function are safe, feasible and worthy of clinical application under the guidance of SLN.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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