摘要
目的探讨早期子宫颈癌患者宫旁淋巴结(PLN)存在与否及其分布、转移规律,进而评估以生物染料法(亚甲蓝染色)结合标本的局部解剖识别 PLN 的临床价值。方法选择接受广泛性子宫切除+盆腔淋巴清扫术治疗的早期子宫颈癌(临床分期Ⅰb～Ⅱa期)患者60例,术前在肿瘤周围的宫颈组织内注射1%亚甲蓝4 ml,术中检查有蓝染的淋巴结为前哨淋巴结(SLN)。术后立刻对切除的子宫标本进行局部解剖,从宫旁软组织中分离出 PLN 送病理检查。结果 60例患者中,38例(63%)患者存在 PLN,共检出 PLN 95枚,PLN 的平均直径为(0.46±0.24)cm。其中,57枚(60%)PLN 位于阔韧带内,沿子宫动脉走向分布;另38枚(40%)分布于主韧带、骶韧带及膀胱宫颈韧带内。95枚 PLN 中,69枚(73%)因被亚甲蓝染色而易于识别,并被认定为宫旁组织内的 SLN。60例患者中,12例(20%)患者共17枚 PLN 有转移,其中2例(3%)PLN 是惟一的转移部位。对于78枚无转移的 PLN 中的36枚进行连续切片及免疫组化染色检查发现,3枚有微小转移灶。结论 PLN 存在于大部分宫颈癌患者的宫旁组织内,且为肿瘤转移的好发部位,但极易被忽视。采用生物染料法结合细致的局部解剖可识别 PLN。
Objective To determine the presence, distribution, and metastasis incidence of parametrial lymph nodes （PLN） of patients with cervical cancer and to investigate the role of lymphatic mapping and topographic section in PLN identification. Methods Sixty patients with early stage （ Ⅰ b - Ⅱ a） cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in the study. Before surgery 4 ml methylene was injected into the cervix around the tumor. The blue-dyed lymph nodes were identified as sentinel lymph nodes （SLN） during operation. An immediate topographic section on uterine specimen was performed to separate the PLN from parametria for pathologic examination. Results Ninety five PLN were presented in 38 （63%） of 60 specimens, with a mean size in diameter of（0.46 ±0. 24）cm. Among the total PLN, 57 （60%） were located parallel to uterine artery through the entire broad ligament, and the other 38 （40%） were scattered in cardinal ligament, sacral ligament and vesicocervical ligament. After lymphatic mapping, 69 （73%） of PLN were dyed and identified as SLN. Parametrial metastasis was found in 12 （20%） patients, and parametrium was the only site containing positive nodes in 2 patients with parametrial metastasis. On routine pathologic evaluation, 17 PLN were found to be positive. Among the remaining 78 PLN, multilevel sectioning in conjunction with immunohistochemical analysis was carried out and 3 PLN containing micrometastases were identified. Conclusions The study shows that PLN are usually found in the parametria, and these nodes often contain metastatic diseases which are easily overlooked. Lymphatic mapping followed by meticulous topographic section is feasible in PLN identification in patients with cervical cancer.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2006年第9期608-611,共4页
Chinese Journal of Obstetrics and Gynecology
