Levenback C, Burke T W, Morris M, Malpica A, Lucas K R, Gershenson D M
Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Gynecol Oncol. 1995 Nov;59(2):216-20. doi: 10.1006/gyno.1995.0011.
We describe early results of and potentially important anatomic findings with intraoperative lymphatic mapping in patients with vulvar cancer.
Isosulfan blue was injected into the dermis at the leading edge of the vulvar lesion in 21 patients. One to five minutes later a standard groin incision was made and carried to the superficial fascia. After gentle dissection, the afferent lymphatic channel and/or sentinel lymph node was identified by its bright blue color. The sentinel node was removed and then the superficial inguinal lymphadenectomy was completed.
The 21 patients, ranging in age from 23 to 85 years (median, 52 years), underwent intraoperative lymphatic mapping. The clinical stages were as follows: T1 in 9, T2 in 10, T3 in 1, and unknown in 1 patient with a prior wide local excision. Two patients had palpably suspicious nodes. Ten patients had lateral lesions, and 11 had midline tumors. Eight of the 11 patients had bilateral groin dissections, making a total of 29 groins dissected. The sentinel node was identified in 18 patients (86%) and in 19 groins (66%). Five patients had unilateral node metastases, and one patient had bilateral node metastases. A sentinel node was found in five of these seven groins. A total of 238 nodes were removed (median, 8.2 nodes per groin). In no case was a nonsentinel node positive if the sentinel node was negative. In one patient the only metastasis was microscopic tumor in the sentinel lymph node. In one case, the sentinel node was found below the cribriform fascia. The sentinel node could not be identified in either groin in one patient with a clitoral primary; however, dye was seen in lymphatic channels passing under the symphysis pubis. The sentinel node was identified in various sites within the superficial compartment including lateral to the femoral artery and at the extreme medial border of the dissection. No complication related to the injection of isosulfan blue was seen.
Intraoperative lymphatic mapping is safe and simple to perform and may help identify the sentinel node, define the extent of superficial inguinal lymphadenectomy, and identify uncommon anatomic variations.
我们描述了外阴癌患者术中淋巴管造影的早期结果及潜在重要的解剖学发现。
对21例患者在外阴病变前缘的真皮内注射异硫蓝。1至5分钟后，做标准腹股沟切口并切至浅筋膜。轻柔解剖后，通过其亮蓝色识别输入淋巴管和/或前哨淋巴结。切除前哨淋巴结，然后完成腹股沟浅淋巴结清扫术。
21例患者年龄在23至85岁之间（中位年龄52岁），接受了术中淋巴管造影。临床分期如下：9例为T1期，10例为T2期，1例为T3期，1例曾接受广泛局部切除的患者分期不明。2例患者可触及可疑淋巴结。10例患者有外侧病变，11例有中线肿瘤。11例患者中有8例行双侧腹股沟清扫，共清扫29个腹股沟。18例患者（86%）和19个腹股沟（66%）识别出前哨淋巴结。5例患者有单侧淋巴结转移，1例患者有双侧淋巴结转移。这7个腹股沟中有5个发现了前哨淋巴结。共切除238个淋巴结（中位值，每个腹股沟8.2个淋巴结）。如果前哨淋巴结为阴性，则无一例非前哨淋巴结为阳性。1例患者唯一的转移是前哨淋巴结中的微小肿瘤。1例中，前哨淋巴结位于筛状筋膜下方。1例阴蒂原发性患者的双侧腹股沟均未识别出前哨淋巴结；然而，在耻骨联合下方的淋巴管中可见染料。前哨淋巴结在浅筋膜内的不同部位被识别，包括股动脉外侧和清扫的最内侧边界。未见与注射异硫蓝相关的并发症。
术中淋巴管造影操作安全、简便，可能有助于识别前哨淋巴结，确定腹股沟浅淋巴结清扫的范围，并识别罕见的解剖变异。
