本文選題：子宮早期惡性腫瘤　切入點：腹腔鏡手術(shù)　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本研究旨在通過在常見子宮早期惡性腫瘤(宮頸癌和子宮內(nèi)膜癌)腹腔鏡手術(shù)中應(yīng)用吲哚箐綠作為示蹤劑行前哨淋巴結(jié)繪圖,探討子宮早期惡性腫瘤腹膜后淋巴結(jié)切除術(shù)中應(yīng)用前哨淋巴結(jié)活檢的識別方法及可行性,評價前哨淋巴結(jié)預(yù)測腹膜后淋巴結(jié)有無腫瘤轉(zhuǎn)移的價值。方法選取診斷明確的子宮早期惡性腫瘤21例,其中包括早期宮頸癌13例,子宮內(nèi)膜癌8例為研究對象。在腹腔鏡手術(shù)開始前于宮頸3點、9點深部間質(zhì)注射吲哚箐綠,腹腔鏡直視下識別最先出現(xiàn)固定高度熒光信號處淋巴結(jié)作為前哨淋巴結(jié)(SLN)并切除,送冰凍及常規(guī)病理檢查。繼續(xù)行(廣泛)全子宮+雙側(cè)輸卵管/卵巢切除+腹膜后淋巴結(jié)切除術(shù)±大網(wǎng)膜切除術(shù)。記錄所有患者切除SLN的顯影位置、時間、數(shù)目、冰凍及常規(guī)病理結(jié)果;記錄所有腹膜后淋巴結(jié)的位置、數(shù)目及病理結(jié)果。結(jié)果1、在21例子宮早期惡性腫瘤患者中,共切除腹膜后淋巴結(jié)889枚,平均每例切除42.3枚。2、在21例子宮早期惡性腫瘤患者中,至少成功檢測到1枚SLN的有20例,共檢出36側(cè),總檢出率為85.7%(36/42)。成功檢測到SLN的20例患者中,檢出94枚SLN,單側(cè)檢出SLN 1-6枚,平均每例患者單側(cè)檢出2.6枚SLN。在宮頸癌患者中SLN分布于閉孔淋巴結(jié)26枚,占40.1%(26/65);髂外淋巴結(jié)21枚,占32.3%(21/65);髂總淋巴結(jié)9枚,占13.8%(9/65);髂內(nèi)淋巴結(jié)9枚,占13.8%(9/65)。子宮內(nèi)膜癌患者中SLN分布于髂外淋巴結(jié)13枚,占44.8%(13/29);髂總淋巴結(jié)12枚,占41.4%(12/29);髂內(nèi)淋巴結(jié)4枚,占13.8%(4/29)。94枚SLN均于術(shù)中送冰凍病理檢查,其中2枚SLN陽性,1枚為子宮內(nèi)膜漿液性腺癌的髂外淋巴結(jié),1枚為宮頸鱗癌的髂總淋巴結(jié)。所有前哨淋巴結(jié)術(shù)中冰凍病理結(jié)果與術(shù)后常規(guī)病理結(jié)果一致。3、20例成功檢測到SLN的患者中,SLN顯影時間為2-19分鐘,平均8.9分鐘。4、本研究中SLN檢測的準確率100.0%(20/20),假陰性率為0,靈敏度為100.0%(2/2),特異度為94.7%(18/19),陽性預(yù)測值為100.0%(2/2),陰性預(yù)測值為100.0%(18/18)。5、SLN的檢出與原發(fā)腫瘤大小、肌層浸潤深度、病理類型、組織分化程度及脈管癌栓浸潤與否等因素?zé)o明顯相關(guān)。結(jié)論1、子宮早期惡性腫瘤宮頸注射吲哚菁綠后腹腔鏡下前哨淋巴結(jié)繪圖具有較高的檢出率與準確率,是一種較為安全可行的方法。2、宮頸癌的前哨淋巴結(jié)常出現(xiàn)在閉孔及髂外淋巴結(jié),子宮內(nèi)膜癌的前哨淋巴結(jié)最常出現(xiàn)在髂外淋巴結(jié),與腹膜后淋巴結(jié)真實轉(zhuǎn)移狀態(tài)具有高度的一致性。前哨淋巴結(jié)對于診斷淋巴結(jié)轉(zhuǎn)移狀態(tài)有較高的診斷效能。3、前哨淋巴結(jié)的檢出與原發(fā)腫瘤大小、肌層浸潤深度、病理類型、組織分化程度及脈管癌栓浸潤與否等因素?zé)o明顯相關(guān)。
[Abstract]:Objective to perform sentinel lymph node mapping by using indocyanine green as a tracer in laparoscopic surgery for common early malignant tumors of the uterus (cervical cancer and endometrial carcinoma). To investigate the identification and feasibility of sentinel lymph node biopsy in retroperitoneal lymphadenectomy for early malignant tumors of uterus. To evaluate the value of sentinel lymph nodes in predicting tumor metastasis in retroperitoneal lymph nodes. Methods 21 cases of early malignant tumors of the uterus were selected, including 13 cases of early cervical cancer. Indocyanine green was injected into the deep stroma of the cervix at 3 o'clock and 9 o'clock before laparoscopic surgery, and the lymph node with fixed high fluorescence signal was first identified as sentinel lymph node (SLN) and resected under the direct vision of laparoscope. Frozen and routine pathological examination. Continue to perform (extensive) hysterectomy of bilateral fallopian tube / ovariectomized retroperitoneal lymphadenectomy 鹵omentectomy. Record the location, time, number of SLN excision in all patients. Frozen and routine pathological findings, location, number and pathological results of all retroperitoneal lymph nodes were recorded. Results 1 among 21 patients with early malignant tumors of the uterus, 889 retroperitoneal lymph nodes were resected. In the 21 cases of early uterine malignant tumor, at least one SLN was successfully detected in 20 cases (36 sides), the total detection rate was 85.7% 42%. Among the 20 cases with successful detection of SLN, 94 SLNs were detected, and 1-6 SLN were detected on one side. An average of 2.6 SLNs were detected on one side in each patient. In cervical cancer patients, there were 26 SLN in obturator lymph nodes (40.1%), 21 cases in external iliac lymph nodes (32.3%), 9 cases in common iliac lymph nodes (13.8%), 9 cases in internal iliac lymph nodes, 9 cases in internal iliac lymph nodes. In endometrial carcinoma, 13 were in the external iliac lymph nodes, 13 were in the external iliac lymph nodes, 13 were in the common iliac lymph nodes; 12 were the common iliac lymph nodes, accounting for 41. 4 / 29; 4 were the internal iliac lymph nodes, accounting for 13. 8 / 429. 94 SLN were sent to the frozen pathological examination during the operation. Of them, 2 were SLN positive and 1 was external iliac lymph node with endometrial serous gland carcinoma. One was the common iliac lymph node of cervical squamous cell carcinoma. The intraoperative frozen pathological results of all sentinel lymph nodes were consistent with those of postoperative routine pathology in 20 cases. The imaging time of SLN was 2-19 minutes. In this study, the accuracy of SLN detection was 100.020 / 20, the false negative rate was 0, the sensitivity was 100.02 / 2, the specificity was 94.775 / 19, the positive predictive value was 100.020 / 2, the negative predictive value was 100.010 / 18.5SLN and the primary tumor size, the depth of myometrial invasion, the pathological type. There was no significant correlation between the degree of tissue differentiation and the infiltration of vascular tumor thrombus. Conclusion 1.Laparoscopic sentinel lymph node mapping after indocyanine green injection has a high detection rate and accuracy. The sentinel lymph nodes of cervical cancer often appear in the obturator and the external iliac lymph nodes, and the sentinel lymph nodes of endometrial carcinoma are most often present in the external iliac lymph nodes. Sentinel lymph nodes are highly consistent with the true metastasis of retroperitoneal lymph nodes. The sentinel lymph nodes have high diagnostic efficacy in the diagnosis of lymph node metastasis. The detection of sentinel lymph nodes is associated with the size of primary tumor, the depth of myometrial infiltration, and the pathological types. There was no significant correlation between the degree of tissue differentiation and the invasion of vascular tumor thrombus.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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