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目的:探讨采用纳米炭注射宫颈在腹腔镜下对宫颈癌前哨淋巴结(SLN)检测的可行性和准确性以及前哨淋巴结在宫颈癌临床应用的价值。方法:收集2008年6月-2010年12月本院妇产科的18例宫颈癌患者临床分期(FIGOⅠb、Ⅱa期)。采用纳米炭注射宫颈后,在腹腔镜下行盆腔淋巴结清扫和广泛子宫切除术,术中将黑染淋巴结确定为前哨淋巴结。切除的淋巴结做常规病理检查和(或)免疫组织化学染色。计算SLN诊断宫颈癌淋巴结转移状态的准确性、敏感性,阴性预测值和假阴性率。结果:腹腔镜下纳米炭注射宫颈后,其宫颈癌前哨淋巴结检出率为100%(18/18),共81枚,占总切除淋巴结的17.31%(81/468),其中,6枚癌转移。前哨淋巴结定位于闭孔37.01%(30/81),骼外29.63%(24/81),骼内22.22%(18/81),宫旁9.88%(8/81),骼总1.23%(1/81)。检出敏感度为100%,准确度为100%,假阴性率为0%。结论:纳米炭注射宫颈后行腹腔镜下,对宫颈癌前哨淋巴结检测技术是可行的,且采用纳米炭注射宫颈后行宫颈癌检测前哨淋巴结具有较高的检出率,SLN可较准确地预测早期宫颈癌患者盆腔淋巴结的病理状态,但还需要大量的研究进一步证实。
Objective: To investigate the feasibility and accuracy of laparoscopic cervical SLN detection using nanocarbon injection of cervix and the clinical value of sentinel lymph node in cervical cancer. Methods: The clinical stage of 18 patients with cervical cancer (FIGOⅠb, Ⅱa) in our hospital from June 2008 to December 2010 were collected. After injecting the cervix with nanocarbon, pelvic lymphadenectomy and extensive hysterectomy were performed laparoscopically. Black stained lymph nodes were identified as sentinel lymph nodes. The resected lymph nodes undergo routine pathology and / or immunohistochemical staining. The accuracy, sensitivity, negative predictive value and false negative rate of SLN in diagnosing cervical lymph node metastasis were calculated. Results: After cervical laparoscopic injection of carbon nanocapsules, the detection rate of sentinel lymph nodes in cervical cancer was 100% (18/18), which accounted for 17.31% (81/468) of the total excised lymph nodes. Six of them Transfer. Sentinel lymph nodes were located in 37.01% (30/81), 29.63% (24/81), 22.22% (18/81) in uterus, 9.88% (8/81) in uterus, 1.23% / 81). The detection sensitivity was 100%, the accuracy was 100% and the false negative rate was 0%. CONCLUSIONS: Nanocarbon injection of cervical posterior laparoscopic technique is feasible for detection of cervical cancer sentinel lymph node, and cervical cancer detection using nanocarbon cervical injection of sentinel lymph node has a high detection rate, SLN can be more accurately predicted Early cervical cancer patients with pelvic lymph node pathology, but still need a large number of studies to further confirm.