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目的通过前哨淋巴结(SLN)的检查结果,预测早期子宫颈鳞癌患者盆腔淋巴结转移情况,以期对子宫颈广泛性切除术(RAT)的安全可靠性进行指导。方法选取2010年3月至2013年3月间收治的早期子宫颈鳞癌患者42例,术前利用核素检测法对患者的SLN进行检测,术中对SLN进行原位切除,同时清扫盆腔淋巴结,术中利用快速冰冻病理检查,确定SLN未发生转移后,行RAT术;术后将盆腔淋巴结和SLN石蜡包埋进行抗角蛋白免疫组化检测和常规病理检查。最后观察患者术中的出血量、手术时间、住院时间及术中术后并发症等指标,评价检测SLN对早期子宫颈鳞癌患者行RAT手术安全可靠性的指导作用。结果收治的42例早期子宫颈鳞癌患者均有SLN检出,共检出140枚SLN,每例患者检出(3.3±1.4)枚,其检出率为100%(42/42);其中3例患者经SLN检测发现淋巴结转移,放弃行RAT术。SLN及其他部位盆腔淋巴结抗角蛋白免疫组化检测未检出HE染色病理检查漏诊的微转移灶。病理证实,未发现非SLN有转移的假阴性及SLN阳性实际无转移的假阳性患者,其阴性预测率高达100%。患者术中平均出血量335 ml,手术平均时间238 min,平均住院时间10.5 d,术中术后共14例出现并发症。结论 SLN检测在早期子宫颈鳞癌患者盆腔淋巴结转移的诊断中有一定价值,对于希望保留生育能力的年轻女性患者在SLN检测结果指导下行RAT手术安全、可靠。
Objective To predict the metastasis of pelvic lymph nodes in patients with early stage cervical squamous cell carcinoma (SLN) through the examination of sentinel lymph node (SLN) so as to guide the safety and reliability of extensive cervical resection (RAT). Methods Forty-two patients with early stage cervical squamous cell carcinoma who were treated from March 2010 to March 2013 were selected. The patients’ SLNs were detected by radionuclide before operation. The SLNs were resected during operation and the pelvic lymph nodes , Rapid intraoperative frozen pathological examination to determine the SLN did not transfer after the line RAT; postoperative pelvic lymph node and paraffin embedded SLN anti-keratin immunohistochemistry and routine pathological examination. Finally observe the intraoperative bleeding, operation time, hospital stay and intraoperative and postoperative complications and other indicators, to evaluate the detection of SLN early cervical squamous cell carcinoma of the RAT operation safe and reliable guidance. Results All the 42 cases of early cervical squamous cell carcinoma were detected by SLN. A total of 140 SLNs were detected, and the detection rate was 100% (42/42) in each case. The detection rate was 100% (42/42) Lymph node metastasis was found in 3 patients by SLN test, and RAT was abandoned. SLN and other parts of the pelvic lymph node anti-keratin immunohistochemistry did not detect HE staining pathological examination missed diagnosis of micrometastasis. The pathology confirmed that no false negatives were found in patients with non-SLN metastases and those without false positives in SLNs. The negative predictive value was as high as 100%. The mean intraoperative blood loss was 335 ml, the average operation time was 238 min and the average length of hospital stay was 10.5 days. Complications were found in 14 cases during the operation. Conclusion The SLN test has some value in the diagnosis of pelvic lymph node metastasis in patients with early cervical squamous cell carcinoma. It is safe and reliable for young female patients who hope to retain fertility under the guidance of SLN test results.