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目的探讨早期子宫颈癌患者宫旁淋巴结(PLN)存在与否及其分布、转移规律,进而评估以生物染料法(亚甲蓝染色)结合标本的局部解剖识别 PLN 的临床价值。方法选择接受广泛性子宫切除+盆腔淋巴清扫术治疗的早期子宫颈癌(临床分期Ⅰb～Ⅱa期)患者60例,术前在肿瘤周围的宫颈组织内注射1%亚甲蓝4 ml,术中检查有蓝染的淋巴结为前哨淋巴结(SLN)。术后立刻对切除的子宫标本进行局部解剖,从宫旁软组织中分离出 PLN 送病理检查。结果 60例患者中,38例(63%)患者存在 PLN,共检出 PLN 95枚,PLN 的平均直径为(0.46±0.24)cm。其中,57枚(60%)PLN 位于阔韧带内,沿子宫动脉走向分布;另38枚(40%)分布于主韧带、骶韧带及膀胱宫颈韧带内。95枚 PLN 中,69枚(73%)因被亚甲蓝染色而易于识别,并被认定为宫旁组织内的 SLN。60例患者中,12例(20%)患者共17枚 PLN 有转移,其中2例(3%)PLN 是惟一的转移部位。对于78枚无转移的 PLN 中的36枚进行连续切片及免疫组化染色检查发现,3枚有微小转移灶。结论 PLN 存在于大部分宫颈癌患者的宫旁组织内,且为肿瘤转移的好发部位,但极易被忽视。采用生物染料法结合细致的局部解剖可识别 PLN。
Objective To investigate the existence, distribution and metastasis of uterine lymph nodes (PLN) in patients with early stage cervical cancer and to evaluate the clinical value of PLN in the local anatomy of biostaining (methylene blue staining) combined with specimens. Methods Sixty patients with early stage cervical cancer (stage Ⅰb-Ⅱa) underwent radical hysterectomy and pelvic lymphadenectomy were treated with 4 ml of 1% methylene blue in the cervical tissue around the tumor before surgery Check for blue-stained lymph nodes as sentinel lymph nodes (SLNs). Immediately after resection of the uterus specimens for local anatomy, isolated from the uterine soft tissue to send PLN for pathological examination. Results Of the 60 patients, PLN was found in 38 patients (63%), with PLN 95 detected and the average diameter of PLN was (0.46 ± 0.24) cm. Among them, 57 (60%) PLN were located in the broad ligament and distributed along the uterine artery. The other 38 (40%) were located in the main ligament, sacral ligament and bladder cervix ligament. Of the 95 PLNs, 69 (73%) were easily identified by methylene blue staining and were identified as SLN in uterine tissue. Of 60 patients, a total of 17 PLN metastases were found in 12 (20%) patients and 2 (3%) PLN were the only metastatic sites. Thirty-six pieces of 78 non-metastatic PLNs were examined by serial sections and immunohistochemical staining. Three of them had micrometastases. Conclusion PLN exists in the uterine tissue of most cervical cancer patients and is a predilection site for tumor metastasis, but it can easily be overlooked. Using biological dye method combined with meticulous local anatomy can identify PLN.