Buist Marrije R, Pijpers Rik J, van Lingen Arthur, van Diest Paul J, Dijkstra Jan, Kenemans Peter, Verheijen René H M
Department of Obstetrics, Nuclear Medicine, and Pathology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Gynecol Oncol. 2003 Aug;90(2):290-6. doi: 10.1016/s0090-8258(03)00277-4.
The purpose of this study was to investigate the feasibility of sentinel node detection through laparoscopy in patients with early cervical cancer. Furthermore, the results of laparoscopic pelvic lymph node dissection were studied, validated by subsequent laparotomy.
Twenty-five patients with early stage cervical cancer who planned to undergo a radical hysterectomy and pelvic lymph node dissection received an intracervical injection of technetium-99m colloidal albumin as well as blue dye. With a laparoscopic gamma probe and with visual detection of blue nodes, the sentinel nodes were identified and separately removed via laparoscopy. If frozen sections of the sentinel nodes were negative, a laparoscopic pelvic lymph node dissection, followed by radical hysterectomy via laparotomy, was performed. If the sentinel nodes showed malignant cells on frozen section, only a laparoscopic lymph node dissection was performed.
One or more sentinel nodes could be detected via laparoscopy in 25/25 patients (100%). A sentinel node was found bilaterally in 22/25 patients (88%). Histological positive nodes were detected in 10/25 patients (40%). One patient (11%) had two false negative sentinel nodes in the obturator fossa, whereas a positive lymph node was found in the parametrium removed together with the primary tumor. In seven patients (28%), the planned laparotomy and radical hysterectomy were abandoned because of a positive sentinel node. Bulky lymph nodes were removed through laparotomy in one patient, and in six patients only laparoscopic lymph node dissection and transposition of the ovaries were performed. These patients were treated with chemoradiation. In two patients, a micrometastasis in the sentinel node was demonstrated after surgery. Ninety-two percent of all lymph nodes was retrieved via laparoscopy, confirmed by laparotomy. Detection and removal of the sentinel nodes took 55 +/- 17 min. Together with the complete pelvic lymph node dissection, the procedure lasted 200 +/- 53 min.
Laparoscopic removal of sentinel nodes in cervical cancer is a feasible technique. If radical hysterectomy is aborted in the case of positive lymph nodes, sentinel node detection via laparoscopy, followed by laparoscopic lymph node dissection, prevents potentially harmful and unnecessary surgery.
本研究旨在探讨腹腔镜下检测早期宫颈癌患者前哨淋巴结的可行性。此外，研究了腹腔镜盆腔淋巴结清扫术的结果，并通过后续剖腹手术进行验证。
25例计划行根治性子宫切除术和盆腔淋巴结清扫术的早期宫颈癌患者接受了宫颈内注射99m锝胶体白蛋白以及蓝色染料。通过腹腔镜γ探头并视觉检测蓝色淋巴结，识别前哨淋巴结并通过腹腔镜分别切除。如果前哨淋巴结的冰冻切片为阴性，则进行腹腔镜盆腔淋巴结清扫术，随后通过剖腹手术行根治性子宫切除术。如果前哨淋巴结在冰冻切片上显示有恶性细胞，则仅进行腹腔镜淋巴结清扫术。
25例患者（100%）均能通过腹腔镜检测到一个或多个前哨淋巴结。22例（88%）患者双侧发现前哨淋巴结。10例（40%）患者检测到组织学阳性淋巴结。1例患者（11%）在闭孔窝有两个假阴性前哨淋巴结，而在与原发肿瘤一起切除的子宫旁组织中发现了一个阳性淋巴结。7例患者（28%）因前哨淋巴结阳性而放弃了计划中的剖腹手术和根治性子宫切除术。1例患者通过剖腹手术切除了肿大的淋巴结，6例患者仅进行了腹腔镜淋巴结清扫术和卵巢移位术。这些患者接受了放化疗。2例患者术后前哨淋巴结显示有微转移。92%的淋巴结通过腹腔镜取出，经剖腹手术证实。前哨淋巴结的检测和切除耗时55±17分钟。连同完整的盆腔淋巴结清扫术，该手术持续200±53分钟。
腹腔镜下切除宫颈癌前哨淋巴结是一种可行的技术。如果在淋巴结阳性的情况下放弃根治性子宫切除术，通过腹腔镜检测前哨淋巴结，随后进行腹腔镜淋巴结清扫术，可避免潜在的有害和不必要的手术。
