SLN 检测结果对早期子宫颈鳞癌行子宫颈广泛性切除术的指导意义

目的通过前哨淋巴结（SLN）的检查结果，预测早期子宫颈鳞癌患者盆腔淋巴结转移情况，以期对子宫颈广泛性切除术（RAT）的安全可靠性进行指导。方法选取2010年3月至2013年3月间收治的早期子宫颈鳞癌患者42例，术前利用核素检测法对患者的SLN进行检测，术中对SLN进行原位切除，同时清扫盆腔淋巴结，术中利用快速冰冻病理检查，确定SLN未发生转移后，行RAT术；术后将盆腔淋巴结和SLN石蜡包埋进行抗角蛋白免疫组化检测和常规病理检查。最后观察患者术中的出血量、手术时间、住院时间及术中术后并发症等指标，评价检测SLN对早期子宫颈鳞癌患者行RAT手术安全可靠性的指导作用。结果收治的42例早期子宫颈鳞癌患者均有SLN检出，共检出140枚SLN，每例患者检出（3．3±1．4）枚，其检出率为100％（42／42）；其中3例患者经SLN检测发现淋巴结转移，放弃行RAT术。SLN及其他部位盆腔淋巴结抗角蛋白免疫组化检测未检出HE染色病理检查漏诊的微转移灶。病理证实，未发现非SLN有转移的假阴性及SLN阳性实际无转移的假阳性患者，其阴性预测率高达100％。患者术中平均出血量335ml，手术平均时间238min，平均住院时间10．5d，术中术后共14例出现并发症。结论SLN检测在早期子宫颈鳞癌患者盆腔淋巴结转移的诊断中有一定价值，对于希望保留生育能力的年轻女性患者在SLN检测结果指导下行RAT手术安全、可靠。

The guidance of SLN detection to radical abdominal trachelectomy of early cervical squamous cellcarcinoma

Objective To predict pelvic lymph node metastasis of early cervical squamous cell carcinoma and provide a guidance of safety and reliability to radical abdominal trachelectomy （RAT） through sentinel lymph node （SLN） detection. Methods Eligible forty-two patients with early cervical squamous cell carcinoma between March 2010 and March 2013 were enrolled in this study. SLN detection was performed using isotope before surgery. Insitu resection was performed, and meanwhile the pelvic lymph nodes were cleaned in operation. After confirming no pelvic lymph node metastasis by utilizing fast frozen biopsy in operation, the RAT was performed. After operation, the pelvic lymph nodes and SLN were embedded using paraffin to make anti-cytokeratin immunohistochemistry examination and routine pathological examination. Finally ,the amount of bleeding, operative time and complications were observed to assess the safety and reliability of RAT in patients with early cervical squamous cell carcinoma. Results SLN checkout was found in all patients, and the number detected SLN wasl40 with an average （3.3 ± 1.4） pieces per patient and a detection rate of 100%. Three out 42 patients gave up RAT due to discovering SLN metastasis. The anti-cytokeratin immunohistochemistry examination did not check out the missed micrometastases foci by HE staining pathological examination in SLN and pelvic lymph nodes. No false negative （having metastasis in non-SLN ） and false positive （no metastasis in fact while SLN positive） cases were found by pathological examination, and its negative predictive rate was 100%. The mean blood loss volume in operation was 335 ml; mean operative time was 238min; intraperative and postoperative complications were seen in 14 cases. Conclusions SLN detection has a certain value for judging pelvic lymph nodes metastasis in patients with early cervical squamous cell carcinoma, and RAT under the guidance of SLN detection is safe and reliable for the young patients who wish to keep the fertility ability.