本文選題：前哨淋巴結(jié)　切入點(diǎn)：子宮內(nèi)膜癌　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究目的是分析子宮內(nèi)膜癌前哨淋巴結(jié)(Sentinel Lymph Node,SLN)的分布、檢出率及SLN對(duì)腹膜后淋巴結(jié)預(yù)測(cè)的準(zhǔn)確性,探討SLN繪圖識(shí)別技術(shù)在子宮內(nèi)膜癌治療中的可行性,為子宮內(nèi)膜癌患者的精準(zhǔn)治療提供幫助。方法:選取2015年7月1日至2016年12月31日于河北醫(yī)科大學(xué)第四醫(yī)院收治的66例子宮內(nèi)膜癌患者,所有患者均于麻醉后手術(shù)前5-10分鐘采用宮頸3、9點(diǎn)(2點(diǎn)法)或2、5、7、11點(diǎn)(4點(diǎn)法)注射亞甲藍(lán),先行SLN切除再行腹腔鏡下系統(tǒng)性淋巴結(jié)切除,對(duì)所有切除的淋巴結(jié)均行蘇木素-伊紅(Hematoxylin-eosin,HE)染色的常規(guī)病理檢測(cè),并對(duì)識(shí)別的SLN行免疫組化細(xì)胞角蛋白(Cytokeratin,CK)微轉(zhuǎn)移病理檢測(cè)。應(yīng)用SPSS21.0軟件進(jìn)行統(tǒng)計(jì)分析,對(duì)檢出率、假陰性率、陰性預(yù)測(cè)值等進(jìn)行統(tǒng)計(jì)描述,計(jì)數(shù)資料采用χ2檢驗(yàn)或Fisher確切概率法,并行一致性Kappa檢驗(yàn)。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1子宮內(nèi)膜癌SLN檢出率為100%,雙側(cè)均檢出SLN占97.0%(64/66),僅單側(cè)檢出SLN占3.0%(2/66,左側(cè)2例),準(zhǔn)確性為100%,假陰性率為0,陰性預(yù)測(cè)值為100%。2 66例子宮內(nèi)膜癌患者共切除SLN 427枚,占切除總淋巴結(jié)的26.1%(427/1637),平均切除SLN 6.47枚/人,平均切除SLN比NSLN少11.86枚/人。3子宮內(nèi)膜癌SLN分布為閉孔區(qū)占53.2%(227/427),髂外區(qū)占23.7%(101/427),髂內(nèi)區(qū)占7.7%(33/427),髂總區(qū)占7.5%(32/427),宮旁區(qū)占0.5%(2/427),腹股溝深區(qū)占0.2%(1/427),腹主動(dòng)脈旁左側(cè)區(qū)占4.4%(19/427),右側(cè)腔靜脈旁區(qū)占1.9%(8/427),骶前區(qū)占0.9%(4/427)。4分析子宮內(nèi)膜癌SLN與腹膜后淋巴結(jié)轉(zhuǎn)移狀態(tài)一致性,Kappa值為1.000,P0.001。5 66例子宮內(nèi)膜癌患者中有3例(共5枚)發(fā)生淋巴結(jié)轉(zhuǎn)移,且均為盆腔SLN轉(zhuǎn)移,非前哨淋巴結(jié)(None Sentinel Lymph Node,NSLN)均無(wú)轉(zhuǎn)移;其中1枚左髂外SLN經(jīng)免疫組化CK微轉(zhuǎn)移病理檢測(cè)證實(shí)為微轉(zhuǎn)移,且為微小轉(zhuǎn)移(Micrometastases,MM)。結(jié)論:1亞甲藍(lán)是很好的子宮內(nèi)膜癌SLN繪圖的示蹤劑,宮頸部位注射示蹤劑是顯示SLN較好的注射途徑,SLN檢出率及陰性預(yù)測(cè)值是評(píng)判此技術(shù)的關(guān)鍵指標(biāo)。2子宮內(nèi)膜癌SLN主要位于閉孔區(qū)和髂外區(qū)。3在子宮內(nèi)膜癌患者中行SLN繪圖識(shí)別技術(shù)是安全、可行的。
[Abstract]:Objective: to analyze the distribution, detection rate and accuracy of SLN in the prediction of retroperitoneal lymph nodes in sentinel Lymph Noden of endometrial carcinoma, and to explore the feasibility of SLN mapping in the treatment of endometrial carcinoma. Methods: from July 1st 2015 to December 31st 2016, 66 patients with endometrial carcinoma were treated in 4th Hospital of Hebei Medical University. All patients were given methylene blue (methylene blue) 5 to 10 minutes before operation. SLN resection was performed first and then systemic lymphadenectomy was performed under laparoscope. All lymph nodes resected were detected by routine pathological examination of Hematoxylin-eosin hehe staining and immunohistochemical cytokeratin CK micrometastasis of SLN. The detection rate and false negative rate were analyzed by SPSS21.0 software. The negative predictive value was statistically described, and the count data were analyzed by 蠂 2 test or Fisher exact probability method. Results the positive rate of SLN in endometrial carcinoma of 1: 1 was 100, and that of both sides was 97.00.64 / 660.Only, SLN was detected on one side (3.0 / 66) and on the left (2 / 66). The accuracy was 100, the false negative rate was 0, and the negative predictive rate was 0. A total of 427 SLN were resected from 1002.66 patients with endometrial carcinoma. 26.1% of the total lymph nodes were resected, with an average of 6.47 SLN per person. Resection of SLN 11.86 fewer than NSLN / Human endometrial carcinoma SLN 53.The distribution of SLN in the obturator area was 53.2i / 427, in the external iliac region was 23.7101 / 427, in the internal iliac region was 7.733 / 427, in the total iliac region was 7.532 / 42727, in the para-uterine area was 0.21/ 427m, in the deep inguinal area was 0.21/ 427m, in the left region of the abdominal aorta was 4.4 / 427s, in the right side of vena cava was 19.4 / 427s. The correlation between SLN and retroperitoneal lymph node metastasis status in endometrial carcinoma was 1.000g P 0.001.5 in 3 out of 66 patients with endometrial carcinoma (n = 5). All of them had pelvic SLN metastasis, none Sentinel Lymph NSLNs had no metastasis, and one of the left SLN was confirmed as micrometastases by immunohistochemical CK micrometastasis. Conclusion 1 methylene blue is a good tracer for SLN mapping of endometrial carcinoma. The detection rate and negative predictive value of cervix injection tracer is a good way to display SLN. 2 the SLN of endometrial carcinoma is mainly located in obturator area and external iliac area in endometrial carcinoma patients. 2. 2. SLN is mainly located in obturator area and external iliac area in patients with endometrial carcinoma. SLN drawing recognition technology is safe, Feasible.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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