發(fā)布時間：2018-03-20 19:51

  本文選題：早期宮頸癌　切入點：前哨淋巴結(jié)　出處：《濟(jì)南大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評價前哨淋巴結(jié)(sentinel lymph node,SLN)檢測結(jié)果預(yù)測早期(FIGO1A1-1B1期)宮頸癌患者盆腔淋巴結(jié)轉(zhuǎn)移狀態(tài),并探討其指導(dǎo)經(jīng)腹廣泛性宮頸切除術(shù)(radical abdominal trachelectomy,RAT)的臨床意義。方法:回顧2006年1月至2015年6月間在山東大學(xué)附屬山東省腫瘤醫(yī)院接受保留生育功能手術(shù)治療的118例FIGO 1A1-1B1期宮頸癌患者作為研究對象,術(shù)前在患者宮頸粘膜下注射放射性核素99mTc-硫膠體,術(shù)中檢測SLN并原位切除,送快速病理檢查排除淋巴結(jié)轉(zhuǎn)移后,行RAT和盆腔淋巴結(jié)清掃,術(shù)后將所有淋巴結(jié)送檢常規(guī)病理同時進(jìn)行抗角蛋白免疫組化檢測確定是否存在微轉(zhuǎn)移灶。通過觀察SLN檢出情況以及RAT的手術(shù)時間、出血量、術(shù)中及術(shù)后并發(fā)癥、復(fù)發(fā)率和妊娠率等,評價SLN檢測結(jié)果對早期(FIGO 1A1-1B1期)宮頸癌患者行RAT手術(shù)的臨床指導(dǎo)意義。結(jié)果:(1)共有114例患者術(shù)中檢測到SLN,共檢出SLN414枚,平均3.6枚/例,檢出率為96.7%,其中,SLN雙側(cè)檢出率為91.2%,單側(cè)檢出率為8.8%,SLN檢出率與患者的年齡、FIGO分期、腫瘤分化程度及大小無明顯相關(guān)性(P值分別為0.722,0.944,0.859,0.629);12例患者因術(shù)中快速病理檢測出SLN轉(zhuǎn)移而轉(zhuǎn)為行廣泛性子宮切除術(shù)(Radical Hysterectomy,RH),其余106例患者行RAT。(2)術(shù)后病理證實盆腔淋巴轉(zhuǎn)移率為11.1%,SLN預(yù)測盆腔淋巴結(jié)轉(zhuǎn)移狀態(tài)的靈敏度為92.3%,特異度為100%,陽性預(yù)測值為100%,陰性預(yù)測值為99%,假陰性率為7.7%,SLN術(shù)中快速病理和術(shù)后病理的符合率為99.1%。104例雙側(cè)盆腔SLN陰性患者術(shù)后病理均未發(fā)現(xiàn)淋巴結(jié)轉(zhuǎn)移。(3)106例患者成功行RAT,中位手術(shù)時長為240min(175-280min),中位出血量為400ml(300ml-1000ml)。術(shù)中并發(fā)癥有子宮動脈損傷(2例)、膀胱肌層損傷(1例)術(shù)后并發(fā)癥以殘余宮頸管狹窄多見,發(fā)生率為18.9%(20/106),其余依次為無感染性盆腔淋巴囊腫9.4%(10/106),下肢水腫5.7%(6/106),停經(jīng)2.8%(3/106)。(4)106例行RAT患者中完成隨訪者103例,中位隨訪時間為90個月。中位無瘤生存期為97個月,復(fù)發(fā)率為3.8%,死亡率為1.9%,妊娠率30.2%。其中,活產(chǎn)7次(均為剖宮產(chǎn)),自然流產(chǎn)8次(孕3月5次,孕6月1次,孕7月2次),2例患者處于妊娠期。結(jié)論:通過放射性核素99mTc-硫膠體進(jìn)行SLN檢測能夠準(zhǔn)確預(yù)測早期宮頸癌患者盆腔淋巴結(jié)的轉(zhuǎn)移狀態(tài),渴望保留生育功能的1A1-1B1早期宮頸癌患者在SLN檢測結(jié)果指導(dǎo)下行RAT安全、可行,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to evaluate the prediction of pelvic lymph node metastasis in patients with early stage FIGO1A1-1B1 (sentinel lymph nodegna). To explore the clinical significance of guiding radical abdominal trachelectomytomy through abdominal resection of cervix. Methods: from January 2006 to June 2015, 118 cases of FIGO treated by preserving fertility in Shandong Cancer Hospital affiliated to Shandong University were reviewed. Patients with stage 1A1-1B1 cervical cancer were studied. Radionuclide 99mTc- sulfur colloid was injected into the cervical submucous membrane of the patients before operation. SLN was detected and resected in situ during the operation. RAT and pelvic lymph node dissection were performed after rapid pathological examination to exclude lymph node metastasis. After operation, all lymph nodes were sent to routine pathology to determine whether there were micrometastases or not. The detection of SLN, the time of RAT operation, the amount of blood loss, the complications during and after operation were observed. The recurrence rate and pregnancy rate were evaluated. The results of SLN were evaluated for the clinical guidance of RAT surgery in patients with early stage Figo 1A1-1B1) cervical cancer. Results there were 114 cases with SLN414 detected during the operation, with an average of 3.6 cases per case. The detection rate of SLN was 96.7%, the detection rate of SLN was 91.2%, the detection rate of unilateral SLN was 8.8% and the age of the patients was Figo stage. There was no significant correlation between tumor differentiation degree and tumor size (P = 0.72222, 0.944, 0.859, 0.629, respectively) in 12 patients who underwent radical hysterectomy or radical hysterectomy due to rapid pathological examination of SLN metastasis during operation, and the other 106 patients underwent RAT.2.) the pelvic lymphatic transformation was confirmed by pathology after operation. The sensitivity, specificity, positive predictive value, negative predictive value, false negative rate and false negative rate of SLN in predicting pelvic lymph node metastasis were 92.3, 92.3, 100, 100, 99 and 99, respectively. The coincidence rate between rapid pathology and postoperative pathology was 99.1% and 99.1% in 104 patients with bilateral pelvic SLN. No lymph node metastasis was found in all patients. RAT3 was successfully performed in 106 patients. The median operative time was 240min / 175-280 min, and the median bleeding volume was 400ml / 300ml-1000ml / min. The complications included uterine artery injury in 2 cases and bladder muscle layer injury in 1 case. Stricture of the remaining cervical canal was common. The incidence rate was 18.920 / 106, followed by non-infectious pelvic lymphoid cyst 9.410 / 106m, lower extremity edema 5.7cr / 106m. 103 of 106 patients with RAT were followed up (median follow-up time was 90 months), and the median survival time was 97 months (median follow-up time was 90 months) in 106 patients with RAT of 2.8T / 10 / 106.The median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months, and the median follow-up time was 90 months. The recurrence rate was 3.8, the mortality was 1.9 and the pregnancy rate was 30.2. Among them, there were 7 live births (all caesarean sections), 8 spontaneous abortions (March 5th pregnancy, June 1st pregnancy). Conclusion: SLN detection with 99mTc- sulfur colloid can accurately predict pelvic lymph node metastasis in early cervical cancer patients. 1A1-1B1 early cervical cancer patients eager to retain fertility function are safe, feasible and worthy of clinical application under the guidance of SLN.
【學(xué)位授予單位】：濟(jì)南大學(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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