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Recherche en cancérologie

腹腔镜检查早期子宫内膜癌的前哨淋巴结定位和活检

Published: August 19, 2021
doi:
10.3791/63044
, , , , ,
1Obstetrics and Gynecology Hospital of Fudan University

Summary

该协议描述了前哨淋巴结的识别和切除，以使手术尽可能简单和微创。

Abstract

前哨淋巴结（SLN）绘图和活检是一种用于可视化和评估癌症淋巴结状态的有前途的技术。这种方法已被权威的国际指南推荐用于低风险子宫内膜癌（EC）患者，但尚未在中国和全球范围内广泛实施。这项工作旨在描述详细的SLN绘图和活检程序，以促进临床应用。在一名低危EC患者中，使用吲哚菁绿（ICG）染料对SLNs进行SLN映射和术后病理超分期，以在腹腔镜检查下追踪SLNs并完全切除它们以进行超分期。总之，该协议描述了ICG注射的细节，以及基于临床实践期间获得的经验在EC患者中的SLN映射和活检。

Introduction

子宫内膜癌（EC）是妇科肿瘤学中最常见的疾病之一，其发病率正在上升1，2。手术是早期EC3，4的一线治疗方法。淋巴结转移的评估是 EC 手术分期的重要组成部分。妇科肿瘤学组（GOG）研究33表明，淋巴结转移与预后不良有关5。

作为评估淋巴结转移的一种新的基本技术，近年来出现了前哨淋巴结（SLN）绘图和活检，并根据国家综合癌症网络（NCCN）子宫癌指南6，7，8，9，10，建议用于明显子宫受限EC的患者。SLN映射也已广泛应用于乳腺癌11、肺癌12、甲状腺癌13和黑色素瘤14等肿瘤。病理超分期在结直肠癌和妇科癌症15、16、17中取得了良好的表现，并被欧洲权威指南推荐18。虽然国际指南10、19中已经提供了EC分期的SLN映射原理，但目前的其他作品中没有详细的手术操作。

这项工作为临床诊断为早期EC的28岁女性进行详细的SLN映射和ICG活检的方案，从而改善和促进了患者的诊断。

Protocol

与本文所述患者相关的所有手术程序均已获得中国上海复旦大学妇产科医院伦理委员会的批准。从患者那里获得了知情同意。 1. EC患者SLN与ICG的映射指征 确保临床诊断患者原发性 EC 局限于子宫内，且低危因素（1 级或 2 级子宫内膜样癌、术前子宫内膜病变≤2 cm，子宫肌膜浸润 <50%）。 确保患者对显影剂 （ICG） 不过敏。 确保患者在疾病发生前没有因任?…

Representative Results

本病例患者为28岁女性，阴道不规则出血2年，4个月前被诊断为子宫内膜异常。经阴道超声检查显示异质性子宫内膜厚度伴附件肿块。在当地一家医院，腹部盆腔磁共振成像（MRI）显示，在高T2WI信号下，子宫腔内有51 mm x 56 mm x 88 mm的肿块，边界清晰。然后，通过宫腔镜检查对她进行评估，并解剖子宫内膜病变。病理结果显示1级子宫内膜癌。这名患者来到医院接受进一步治疗，对生育能力有很强的?…

Discussion

SLN绘图和活检是一种更具选择性和定制性的淋巴结清扫方法，已在临床上应用了近20年。在EC领域，SLN映射和活检因其在早期EC中的高诊断效率而越来越多地被一些指南推荐，总体和双侧检率分别达到89%-95%和52%-82%，敏感性为84%-100%，阴性预测值为97%-100%22。本研究报告了一位典型的EC患者，他进行了SLN映射，并详细描述了从ICG注射到SLN活检的SLN方案。

SLN映射对?…

Divulgations

The authors have nothing to disclose.

Acknowledgements

这项工作得到了国家自然科学基金（81772777）、上海市科学技术委员会医学指导项目（18411963700）、上海市科学技术发展研究中心临床研究计划（No.SHDC2020CR4079）;上海浦江人才项目（17PJ1401400）。感谢复旦大学妇产科马奉华及时提供的MR影像帮助和复旦大学妇产科病理影像的王超及时帮助。

Materials

2-mL syringe Becton, Dickinson and Company, USA 301940
Coagulation forceps Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory D0A010
Fluorescence microscope Olympus IX73
Harmonic scalpel Soering GmbH SONOCA190
Hematoxylin-eosin staining Beyotime Biotechnologies Corporation,CN C0107
Immunohistochemical cytokeratin staining MXB Biotechnologies Corporation, CN Kit-0020
Indocyanine green (ICG) Dandong Medical Innovation Pharmaceutical Corporation. 3599-32-4
Pararaffin Sangon biotech Co., Ltd. A601889
Pinpoint Endoscopic Fluorescence Imaging system Novadaq Technoloies Bonita, Springs, FL NA
Propofol Injection Fresenius Kabi Deutschland GmbH D-61346 Bad Homburg v.d.H., Germany H20030124
Silk Braided non-absorbable suture Shanghai Ethicon SA854G
Silk thread Beijing AKIN AIEN International Medical Technology Co.,Ltd. VCPP71D
Suction-Irrigation Tube Shanghai SMAF YX980D
Toothless forceps Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory J41010
Trocar ETHICON Co,. Ltd, USA B10LT, B5LT
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Tags

Sentinel Lymph Node MappingSentinel Lymph Node BiopsyEndometrial CancerEarly StageLaparoscopyMinimally InvasiveLymph Node MetastasisPathological UltrastagingLearning CurveFluorescence ImagingPeritoneal WashingsCytologyPelvic Lymphadenectomy
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Wang, B., Xue, Y., Wang, Q., Xu, Y., Chen, X., Wang, C. Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy. J. Vis. Exp. (174), e63044, doi:10.3791/63044 (2021).
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