【摘要】 目的探讨核素法对宫颈癌前哨淋巴结(SLN)定位的可行性及术前核素显像对术中快速、准确定位SLN的作用。方法20例按国际妇产科学联盟(FIGO)标准诊断为Ⅰb或Ⅱa期宫颈癌患者,于其肿瘤周围多点、对称注射99Tcm硫胶体,行即刻平面显像及断层显像(定位)或视情况行延迟显像;10～12h后术中行“热点”γ探测,并在核素注入点处注入4ml生物染料,记录蓝染淋巴结的部位和数目,再行常规盆腔淋巴结清扫术并进行活组织检查。分析各“热点”、蓝染淋巴结的相互关系和病理结果。结果20例患者核素法、染料法联合探测SLN检出率100%(5353枚),无假阴性。术中γ探测检出率925%(4953枚),染料法检出率887%(4753枚),两法符合率为75%(1520例)。13例术前显像定位的SLN区域与γ探测相符,符合率为65%(1320例)。结论核素法可用于寻找宫颈癌SLN,联合染料法可提高SLN的检出率;术前显像可试用于指导术中快速定位SLN。更多还原

【Abstract】 Objective To investigate the feasibility of sentinel lymph node (SLN) detection after radionuclide injection as well as the significance of lymphoscintigraphical guidance in rapid search for SLNs in surgery in cervical cancer patients. Methods 10～12 h before surgery, 20 patients with cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰb or Ⅱa underwent instant or delayed lymphoscintigraphy and positioning tomography after intracervical injection of ~99 Tcm-sulphur colloid (SC). In surgery, a hand-held γ ray detection probe was used to find the ‘hot spot’. Besides, 4 ml blue dye was injected around the cervical lesion and the blue sentinel lymph nodes (BSLN) were recorded. Then the conventional pelvic node exsection and node biopsy were performed. The mutual relation between the two methods and the pathological results were analyzed. Results Combining the two methods we detected all the SLNs in the 20 patients, the detection rate reached 100% while the false negative rate was 0%. γ-detection rate was 92.5% (49/53) whereas blue dye detection rate was 88.7%(47/53); the complete congruence of the two methods reached 75%(15/20). In 13 patients, lymphoscintigraphy showed the same SLNs region as γ-detection did, the rate was 65%(13/20). Conclusions Radionuclide could be used to detect SLNs in cervical cancer, and the detection rate would be raised if it is combined with blue dye injection. Presurgical lymphoscintigraphy is likely to direct positioning SLNs rapidly in surgery.更多还原