| 孔德强,李春静,盛修贵.前哨淋巴结检测结果指导肿瘤＞2cm的Ⅰb1期宫颈癌行广泛性宫颈切除术的临床研究[J].肿瘤学杂志,2016,22(12):998-1003. |
| 前哨淋巴结检测结果指导肿瘤＞2cm的Ⅰb1期宫颈癌行广泛性宫颈切除术的临床研究 |
| Detection of Sentinel Lymph Nodes as Indicator for Radical Abdominal Trachelectomy in StageⅠb1 Cervical Cancer with Tumor ＞2cm |
| 投稿时间：2016-04-21 |
| DOI：10.11735/j.issn.1671-170X.2016.12.B004 |
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| 中文关键词: 宫颈肿瘤 前哨淋巴结 生育力 宫颈切除术 |
| 英文关键词:cervical neoplasms sentinel lymph node fertility trachelectomy |
| 基金项目:山东省医药卫生科技发展计划项目（2016WS0324）；山东省泰山学者项目（ts201511073） |
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| 中文摘要: |
| 摘 要：［目的］ 评价前哨淋巴结（SLN）对肿瘤＞2cm的Ⅰb1期宫颈癌患者盆腔淋巴结转移状态的预测价值，并探讨SLN检测结果指导经腹广泛性宫颈切除术（RAT）的临床意义。［方法］ 对45例保留生育功能治疗的肿瘤＞2cm的Ⅰb1期宫颈癌患者，术中检测SLN并原位切除，送快速冰冻病理检查排除盆腔淋巴结转移后，行RAT和盆腔淋巴清扫，术后将SLN和盆腔其他淋巴结送常规病理检查和抗角蛋白免疫组化检测。观察患者手术时间、术中出血量、术中术后并发症及术后复发、妊娠情况等指标，评价SLN检测指导肿瘤＞2cm的Ⅰb1期宫颈癌患者行RAT手术的可行性和安全性。［结果］ 45例患者均检出SLN，共检出145枚，平均3.2枚/例，检出率100.0%（45/45）。4例因术中快速冰冻病理发现SLN转移而改行广泛性子宫切除+盆腔淋巴清扫术，其余41例均成功行RAT。术后病理检查发现1例有1枚非SLN转移，SLN假阴性率为2.2%(1/45)，SLN阴性预测值为97.6%(40/41)。抗角蛋白免疫组化检测未检出常规病理检查漏诊的微转移灶。SLN术中冰冻病理和术后病理的符合率为97.8%（44/45）。术中2例损伤一侧子宫动脉、1例损伤膀胱肌层，术后7例出现盆腔淋巴囊肿，3例残余宫颈管狭窄。术后完成随访38例，中位随访时间61个月，随访率为92.7%。术后19例有生育要求，5例妊娠，妊娠率26.3%。随访期间，2例复发，复发率为5.3%（2/38）。［结论］ SLN检测结果能准确预测肿瘤＞2cm的Ⅰb1期宫颈癌患者的盆腔淋巴结转移状态。希望保留生育功能的肿瘤＞2cm的Ⅰb1期宫颈癌患者，在SLN检测结果指导下行RAT是安全可行的。 |
| 英文摘要: |
| Abstract：［Objective］ To assess the clinical value of sentinel lymph nodes (SLN) detection as indicator for radical abdominal trachelectomy (RAT) in stageⅠb1 cervical cancer with tumors＞2cm. ［Methods］ Forty-five patients with stageⅠb1 cervical cancer and tumors ＞2cm were enrolled in this study. SLNs were detected with 99mTc-labeled phytate before surgery. In situ resection was performed and meanwhile the pelvic lymph nodes were dissected. After confirming no pelvic lymph node metastasis by utilizing fast frozen biopsy in operation，RAT was performed. The pelvic lymph nodes and SLN were submitted to routine pathological examination and cytokeratin immunohistochemistry. Intraoperative blood loss，operation time and complications were observed. ［Results］ SLN was detected in all patients（100.0%）； the total number of detected SLN was 145 with an average of 3.2 per patient. SLN of 4 patients were positive on frozen sections and the patients were converted to radical hysterectomy，and the other 41 patients with negative SLN underwent RAT successfully. Among the 41 patients who were managed with RAT，1 patient was found to have 1 non-SLN on pathology. The cytokeration immunohistochemistry examination did not find the missed micrometastasis foci by HE staining pathological examination in SLN and pelvic lymph nodes. The sensitivity，specificity，negative predictive value and the false negative rate were 80.0%，100.0%，97.6%，and 2.2%，respectively. The coincidence rate of SLN in frozen section with postoperative pathology was 97.8% (44/45). Surgical complications occurred in 13 cases，including 2 cases of uterine artery injury and 1 case of bladder injury，7 cases of pelvic lymphocyst and 3 cases of residual cervical canal stenosis. The median follow-up time was 61 months (4~143 months)； 38 patients completed follow-up with a follow-up rate of 92.7% (38/41). Nineteen of the 38 patients with procreative desire conceived 5 pregnancies after the fertility-sparing surgery. Two patients had disease recurrence during follow-up with a recurrence rate of 5.3%（2/38）.［Conclusion］ SLN detection can predict pelvic lymph nodes status in stageⅠb1 cervical cancer with tumors ＞2cm. Under the guidance of SLN detection，RAT is a safe and reliable fertility-sparing treatment for the young patients who strongly wish to preserve their fertility. |
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