摘要
目的:探究吲哚菁绿(ICG)荧光显影技术指导子宫内膜癌(EC)分期手术的应用效果及对腹膜后淋巴结转移的预测价值。方法:收集2022年3月-2024年3月本院行腹腔镜全面分期手术的EC患者98例临床资料。均术前于宫颈注射ICG,采用ICG荧光显影技术辅助切除盆腔及腹部淋巴结,并对荧光显影和未显影的淋巴结进行病理送检,分析ICG荧光显影情况、淋巴结清除情况,以病理诊断为金标准分析ICG荧光显影技术对腹膜后淋巴结转移的诊断价值,分析影响多区域淋巴结ICG荧光显影的相关因素。结果:98例EC患者成功显影91例,显影率为92.9%,共显影994枚淋巴结节,其中盆腔淋巴结851枚(85.6%),腹主动脉淋巴结67(6.7%),骶前淋巴结58枚(5.8%),腹股沟深淋巴结9(0.9%);98例手术患者中腹膜后淋巴结转移阳性34例(34.7%),91例成功显影者中32例(35.2%)腹膜后淋巴结转移阳性。98例共切除淋巴结1578枚,淋巴结转移阳性132枚(8.4%),91例成功显影的患者手术共清除淋巴结1422枚,其中ICG荧光显影994枚,转移阳性122枚,占显影总数的12.3%,所有患者中未发生转移而行淋巴结切除术患者占比65.3%(64/98),未转移淋巴结切除率为91.6%(1446/1578)。ICG荧光显影技术诊断EC患者腹膜后淋巴结转移的敏感度90.6%,特异度91.5%,准确率91.2%,阳性预测值85.3%,阴性预测值94.7%,Kappa值为0.810>0.75,与病理诊断一致性较高;多因素logistic回归分析,操作者经验≤10年、肌层浸润深度≥1/2、淋巴管间隙浸润阳性是影响ICG腹膜后多区域淋巴结显影阴性的危险因素(均P<0.05)。结论:ICG荧光显影技术对淋巴结转移有较好诊断价值,可用于指导EC分期手术中腹膜后淋巴结清除。
Objective: To explore the application effect of indocyanine green(ICG) fluorescence imaging technique in guiding the staging surgery of endometrial cancer(EC) of patients, and to study the predictive value of indocyanine green(ICG) fluorescence imaging technique for the endometrial cancer metastasis in the retroperitoneal lymph node of the patients. Methods: The clinical data of 98 patients with EC who received the laparoscopic comprehensive staging surgery in the hospital from March 2022 to March 2024 were collected in this study. ICG was injected into the cervix of these patients before surgery. ICG fluorescence imaging technique was used to assist the resection situation of the pelvic and abdominal lymph nodes of the patients. The lymph nodes with and without fluorescence imaging of the patients after surgery were sent for the pathologic examination. The situation of the ICG fluorescence imaging of the lymph node and the lymph node clearance of the patients were analyzed. With the pathological diagnosis as the gold standard, the diagnostic value of ICG fluorescence imaging technique for the retroperitoneal lymph node metastasis of the patients was analyzed. The related factors affecting the ICG fluorescence imaging of the multi-regional lymph nodes of the patients were analyzed.Results:The ICG fluorescence imaging of the lymph nodes of 91patients in 98patients with EC were successfully developed,with a development rate of 92.9%(994lymph nodes).In 994lymph nodes developed,there were 851(85.6%)pelvic lymph nodes,67(6.7%)abdominal aortic lymph nodes,58(5.8%)presacral lymph nodes and 9(0.9%)inguinal deep lymph nodes.Among 98patients with surgical treatment,there were 34(34.7%)cases with the positive retroperitoneal lymph node metastasis.Among 91patients with the successful lymph node developed,there were 32(35.2%)cases with the positive retroperitoneal lymph node metastasis.A total of 1578lymph nodes of 98patients were resected,and there were 132(8.4%)lymph nodes with the EC metastasis.1422lymph nodes of 91patients with successful lymph nodes developed were removed during the surgery,and among them,994lymph nodes were visualized by ICG fluorescence,and there were 122(12.3%)lymph nodes with the EC metastasis.Among all these patients,65.3%(64/98)patients without EC metastasis of lymph nodes had undergone the lymph node resection,and the resection rate of the lymph node without EC metastatic was 91.6%(1446/1578).The sensitivity,the specificity,the accuracy,the positive predictive value,the negative predictive value and Kappa value of the ICG fluorescence imaging of the lymph node of the patients with EC for diagnosing their retroperitoneal lymph node metastasis were 90.63%,91.53%,91.21%,85.29%,94.74%and 0.810>0.75,respectively,and all of which were in high consistency with the pathological diagnosis results of the patients.Multivariate Logistic regression analysis showed that the operator experience≤10years,the depth of the myometrial invasion of EC ≥1/2and the positive lymphatic space invasion of the patients with EC were the risk factors affecting their negative development of retroperitoneal multi-regional lymph nodes in ICG(all P<0.05).Conclusion:ICG fluorescence imaging technique has good diagnostic value for the lymph node metastasis of the patients with EC,and which can be used to guide the retroperitoneal lymph node dissection during the staging surgery of the patients with EC.
作者
谭慧
马金枝
祝莉
郭克锋
TAN Hui;MA Jinzhi;ZHU Li;GUO Kefeng(Sanmenxia Yellow River Hospital,Sanmenxia,Henan Province,472000)
出处
《中国计划生育学杂志》
2025年第2期434-438,共5页
Chinese Journal of Family Planning
基金
河南省医学科技攻关计划项目(LHGJ20221041)。
关键词
子宫内膜癌
吲哚菁绿
荧光显影
淋巴结转移
预测价值
影响因素
Endometrial cancer
Indocyanine green
Fluorescence imaging
Lymph node metastasis
Predictive value
Influencing factor
