【摘要】 目的探讨早期宫颈癌患者前哨淋巴结（SLN）检测的快速术中诊断方法和临床价值。方法采用联合放射性同位素和蓝染法对30例早期宫颈癌患者行 SLN 检测,按 FIGO 分期,30例患者中ⅠB1期14例,ⅡA期16例。于术前在宫颈3′、6′、9′、12′各注射^99mTc-硫胶体0.4 mci/0.4 ml,开腹后在宫颈4个相同部位注射亚甲蓝各1 ml,术中识别 SLN,即蓝染淋巴结和/或热点淋巴结,并原位切除 SLN,然后行经腹广泛子宫切除+盆腔淋巴切除术。术中行印片细胞学和快速冰冻检查以检测SLN 是否转移,比较 SLN 术中印片细胞学及快速冰冻检查和 HE 染色检查结果。结果30例患者中29例检出 SLN,检出率为96.7%,HE 检查示盆腔淋巴结转移者9例。检出 SLN 的29例中8例 SLN阳性,20例 SLN 阴性,1例 SLN 假阴性。SLN 检测的灵敏性为88.9%、准确性为96.6%,假阴性率为11.1%。SLN 术中快速冰冻和印片细胞学检查的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为92.3%、100%、98.9%、100%、98.8%和92.3%、97.6%、96.8%、85.7%、98.8%。结论冰冻切片和印片细胞学病理检查是术中快速诊断 SLN 转移状态的可选择方法;SLN 检测对宫颈癌盆腔淋巴结转移具有预测性。更多还原

【Abstract】 Objective To study the effective method for rapid detection of sentinel lymph nodes in patients with early stage cervical cancer and clinical value thereof.Methods Thirty female patients with early stage cervical cancer,14 at FIGO stage Ⅰ B1 and 16 at stage Ⅱ A,underwent injection of ^99mTc-labelled sulfur colloid 0.4 mci/0.4 ml at the positions of 3,6,9,and 12 o’clock of the cervix 5 h or 18 h before operation,and injection of 1 ml of methylene blue at the same cervical positions as mentioned above after the abdomen was opened.The blue-stained lymph nodes or the lymph nodes directed by the blue-stained lymph vessels were identified as SLNs:γ-detector was used to position the hot nodes.The SLNs were resected and then radical hysterectomy and pelvic lymphadenectomy were performed.SLN frozen section and imprint cytology were conducted during the operation,the results were compared with that of HE staining Results SLN were detected successfully in 29 of the 30 patients with a detection rate of 96.7%.Routine HE staining indicated pelvic lymph node metastasis in 9 patients.The SLN was positive in 8 of the 29 patients, negative in 20 patients,and false negative in 1 patient.The sensitivity,accuracy,and false-negative rates of SLN detection were 88.9%,96.6%,and 11.1% respectively.The sensitivity,specificity,accuracy,and positive and negative predictive rates were 92.3%,100%,98.9%,100%,and 98.8% for frozen section, and 92.3%,97.6%,96.8%,85.7%,and 98.8% for imprint cytology respectively.Conclusion Frozen section and imprint cytology may be effective rapid methods to diagnose SLN metastasis during operation.SLN detection can predict pelvic lymph node metastasis in cervical cancer.更多还原