卵巢固有韧带联合宫颈注射双示踪剂定位高危子宫内膜癌盆腔及腹主动脉旁前哨淋巴结的初步探究OA
Preliminary study on dual-tracer in high-risk endometrial cancer using proper ovarian ligament and cervical injections for pelvic and para-aortic sentinel lymph node mapping
目的 初步探究在高危子宫内膜癌患者腹腔镜手术中,卵巢固有韧带联合宫颈注射双示踪剂定位盆腔和腹主动脉旁前哨淋巴结(sentinel lymph node,SLN)的可行性及潜在显示价值.方法 采用单中心、前瞻性观察性研究方法,以2025年1月5日至2026年2月10日于广西医科大学附属肿瘤医院接受腹腔镜手术的10例高危子宫内膜癌患者(术前FIGO 2009分期为ⅠA～Ⅱ期)为研究对象.采用卵巢固有韧带注射吲哚菁绿(indocyanine green,ICG)联合宫颈注射亚甲蓝的双示踪技术,对盆腔及腹主动脉旁SLN进行分区定位.记录患者双侧盆腔及腹主动脉旁SLN显影率、解剖位置、病理结果及围手术期并发症情况.结果 10例患者均完成双示踪剂SLN定位.右侧和左侧腹主动脉旁SLN的显影率分别为100%(10/10)、90%(9/10),右侧和左侧盆腔SLN的显影率分别为80%(8/10)、70%(7/10).右侧腹主动脉旁SLN多位于腹主动脉分叉右上方2～3 cm,左侧多位于肠系膜下动脉至左肾静脉下方区域;盆腔SLN多位于髂外血管内侧和闭孔区上部.病理检查示1例为孤立性腹主动脉旁淋巴结转移,1例盆腔及腹主动脉旁SLN均为阳性.所有患者术后1周均未发生淋巴漏等并发症.结论 卵巢固有韧带注射ICG联合宫颈注射亚甲蓝双示踪剂技术,在高危子宫内膜癌盆腔及腹主动脉旁SLN的术中定位具有一定可行性和潜在显示价值,但其诊断效能及临床意义仍需更大样本研究验证.
Objective To preliminarily investigate the feasibility and potential visualization value of dual-tracer for pelvic and para-aortic sentinel lymph node(SLN)mapping during laparoscopic surgery in patients with high-risk endometrial cancer.Methods This single-center,prospective observational study enrolled ten patients with high-risk endometrial cancer who underwent laparoscopic surgery at Guangxi Medical University Cancer Hospital between January 5,2025 and February 10,2026.All patients were classified as preoperative clinical stage of Ⅰ A-Ⅱ according to the 2009 FIGO staging system.The dual-tracer technique was performed,with indocyanine green(ICG)injected into the proper ovarian ligament and methylene blue injected into the cervix,to achieve regional mapping of pelvic and para-aortic SLN.The bilateral detection rates,anatomical locations,pathological results of pelvic and para-aortic SLN and perioperative complications were recorded.Results Dual-tracer SLN mapping was successfully completed in all 10 patients.The detection rates of right and left sides para-aortic SLN were 100%(10/10)and 90%(9/10),respectively,and the detection rates of right and left sides pelvic SLN were 80%(8/10)and 70%(7/10),respectively.Right sides para-aortic SLN were mainly located 2-3 cm above the right side of the aortic bifurcation,whereas left sides para-aortic SLN were mainly located between the inferior mesenteric artery and the area below the left renal vein.Pelvic SLN were mainly located in the medial external iliac region and the upper obturator region.Pathological examination revealed one case of isolated para-aortic lymph node metastasis,and one case with positive SLN in both pelvic and para-aortic regions.No postoperative complications such as lymphatic leakage occurred in any patient within 1 week after surgery.Conclusions The dual-tracer technique combining ICG injection into the proper ovarian ligament and methylene blue in-jection into cervical is clinically feasible and demonstrates promising visualization value for intraoperative mapping of pelvic and para-aortic SLN in patients with high-risk endometrial cancer.However,its diagnostic performance and clinical significance require fur-ther validation in large-sample studies.
农艳瑾;韦有生;黄芳依;邵如玉;姚德生
530021 南宁 广西医科大学附属肿瘤医院妇瘤科530021 南宁 广西医科大学附属肿瘤医院妇瘤科530021 南宁 广西医科大学附属肿瘤医院妇瘤科530021 南宁 广西医科大学附属肿瘤医院妇瘤科530021 南宁 广西医科大学附属肿瘤医院妇瘤科
医药卫生
高危子宫内膜癌双示踪剂前哨淋巴结卵巢固有韧带腹主动脉旁淋巴结
High-risk endometrial cancerDual-tracerSentinel lymph nodeProper ovarian ligamentPara-aortic lymph node
《中国癌症防治杂志》 2026 (2)
156-161,6
广西重点研发计划项目(桂科AB17292092)广西南宁市青秀区重点研发计划项目(2021005)
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