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背景与目的:近几年已开展宫颈癌前哨淋巴结(sentinellymphnode,SLN)的研究,目前影响宫颈癌SLN的检出还存在很多未知因素。本研究使用亚甲蓝作为示踪剂检测宫颈癌SLN,分析影响SLN检出的因素。方法:41例宫颈癌Ⅰb1～Ⅱb期患者,术前90～400min在宫颈瘤周分4～6点注射亚甲蓝2～4ml,蓝染淋巴结即定为SLN,术后将SLN行多层切片HE染色和细胞角蛋白(cytokeratin,CK)免疫组化,其余淋巴结作常规病理检查,根据SLN检出率、假阴性率来探讨使用亚甲蓝检测宫颈癌SLN的影响因素。结果:41例中,31例成功定位出SLN共85枚,总检出率为75.6%,最常见部位为闭孔窝淋巴结。其中未行术前放化疗者检出率为87.0%(20/23);已行术前放化疗者检出率为61.1%(11/18)。27例注射亚甲蓝量为2～3ml的患者检出率仅为63.0%(17/27),显著低于注射量为3.4～4ml的患者(100%,14/14)。病理结果示:一共8例患者有盆腔淋巴结转移。结论:使用亚甲蓝检测宫颈癌SNL的注射剂量以3～4ml为宜。宫颈癌SLN定位个体差异较大,以闭孔窝最多见。
BACKGROUND & AIM: Sentinellymphnode (SLN) has been studied in cervical cancer in recent years. There are still many unknown factors affecting the detection of SLN in cervical cancer. In this study, methylene blue was used as a tracer to detect cervical cancer SLN, analysis of SLN detection factors. Methods: Forty-one patients with stage Ⅰb1 ~ Ⅱb cervical cancer were treated with 2 ~ 4ml of methylene blue at 4 ~ 6 points of cervical tumor at 90 ~ 400min before operation. The blue-stained lymph nodes were designated as SLN. After operation, HE staining and cytokeratin (CK) immunohistochemistry, the remaining lymph nodes for routine pathological examination, SLN detection rate based on the false negative rate to explore the use of methylene blue SLN cervical cancer risk factors. Results: Among the 41 cases, 31 SLNs were successfully located in 85 cases with a total detection rate of 75.6%. The most common sites were closed-cell lymph nodes. Among them, the rate of preoperative radiochemotherapy was 87.0% (20/23), while the preoperative radiochemotherapy was 61.1% (11/18). The detection rate was only 63.0% (17/27) in 27 patients with methylene blue dose of 2 ~ 3ml, which was significantly lower than that of patients with injection volume of 3.4 ~ 4ml (100%, 14/14). Pathological results show: a total of 8 patients with pelvic lymph node metastasis. Conclusion: The detection of cervical cancer SNL injection of methylene blue to 3 ~ 4ml appropriate. Cervical SLN positioning individual differences larger to closed hole nest most see.