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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (02): 100 -105. doi: 10.3877/cma.j.issn.1674-6899.2022.02.008

论著 上一篇    

前哨淋巴结活检联合病理超分期在子宫内膜癌中的研究
邓媛1, 邓黎1, 冯春2, 姚远洋1, 唐帅1, 谭文唯1, 钟魁艳1, 王延洲1,†()   
  1. 1. 400038　重庆，陆军军医大学第一附属医院妇产科
    2. 400038　重庆，陆军军医大学第一附属医院病理科
  • 收稿日期:2021-12-07 出版日期:2022-04-30
  • 通信作者: 王延洲
  • 基金资助:
    陆军军医大学临床医学科研人才培养计划(2018XLC3002); 重庆市卫生适宜技术推广项目(2021jstg010)

Study of sentinel lymph node biopsy combined with pathological ultrastaging in endometrial carcinoma

Yuan Deng1, Li Deng1, Chun Feng2, Yuanyang Yao1, Shuai Tang1, Wenwei Tan1, Kuiyan Zhong1, Yanzhou Wang1,†()   

  1. 1. Department of Gynecology and Obstetrics, First Affilisted Hospital, Army Medical University, Chongqing 400038, China
    2. Pathology Department, First Affilisted Hospital, Army Medical University, Chongqing 400038, China
  • Received:2021-12-07 Published:2022-04-30
  • Corresponding author: Yanzhou Wang
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目的

探讨在子宫内膜癌精准治疗中前哨淋巴结活检(sentinel lymph node biopsy，SLNB)联合病理超分期技术的临床价值。

方法

采用基于倾向得分匹配的回顾性队列研究方法，分析2018年8月至2020年8月于陆军军医大学第一附属医院妇产科因子宫内膜癌行腹腔镜全面分期手术的552例患者资料，其中43例行SLNB(SLNB组)并对前哨淋巴结行病理超分期、509例行系统性淋巴结切除(systematic lymphadenectomy，SLD)(SLD组)，进行1∶2倾向得分匹配，以最小化两组间因基线特征不平衡而产生的偏差，最终获得SLNB组41例、SLD组82例。对比分析两组淋巴结检出的阳性率、临床病理分期的准确性、围手术期指标(手术时间、术中出血量和并发症发生率)等。

结果

123例患者中，SLNB组与SLD组相比，淋巴结检出的阳性率2.4%比1.2%，两组间差异无统计学意义(P>0.05)；手术时间(128.0±38.2)min比(146.7±57.7)min、术中出血量(114.2±82.0)ml比(155.2±87.9)ml、术后并发症发生率0比1.2%，两组间差异有统计学意义(P<0.05)；术后24 h内肛门排气率39.0%比28.0%、术后留置引流时间(1.4±1.4)d比(2.9±1.5)d、术后住院时间(5.6±2.9)d比(6.4±2.5)d，两组间差异无统计学意义(P>0.05)。

结论

在子宫内膜癌的治疗中，相比于SLD，SLNB联合病理超分期可以达到相似的淋巴结检出阳性率，但手术时间更短、术中出血量更少、术后并发症发生率相对更低。

关键词: 子宫内膜癌, 前哨淋巴结活检, 病理超分期, 系统性淋巴结切除
Objective

To discuss the clinical value of sentinel lymph node biopsy combined with pathological ultrastaging in the precise treatment of endometrial cancer.

Methods

A retrospective cohort study based on propensity score matching was designed to include 552 patients who underwent laparoscopic staging surgery for endometrial cancer in the Department of Obstetrics and Gynecology, The First Affiliated Hospital of The Army Medical University from Aug. 2018 to Aug. 2020, There were 43 cases with sentinel lymph node biopsy combined with pathological ultrastaging (SLNB group) and 509 cases with systematic lymphadenectomy (SLD group).A 1∶2 propensity score matching was performed to minimize the bias due to the imbalanced baseline features between the two groups.Finally, 41 cases in SLNB group and 82 cases in SLD group were obtained.We compared and analyzed the positive rate of lymph node detection, accuracy of clinicopathological staging and perioperative indicators (such as operative time, intraoperative blood loss and incidence of complications).

Results

Among 123 patients, the SLNB group was compared with the SLD group, the positive rate of lymph node detection was (2.4% vs 1.2%) , and there was no statistical difference between the two groups (P> 0.05).The operative time was [(128.0±38.2)min vs (146.7±57.7)min], the intraoperative blood loss was[ (114.2±82.0)ml vs (155.2±87.9) ml], and the incidence of postoperative complications was 0 vs 1.2%, of which the difference was statistically significant (P<0.05).There were no statistically significant differences in rate of anal exhaust within 24 h (39.0% vs 28.0%), postoperative indwelling drainage time[(1.4±1.4)d vs (2.9±1.5) d], postoperative hospital stay [ (5.6±2.9)d vs (6.4±2.5)d] between the two groups (P>0.05).

Conclusions

Sentinel lymph node biopsy combined with pathological ultrastaging has similar detection rates as systematic lymphadenectomy in the treatment of endometrial cancer, but the former has shorter operative time, less intraoperative blood loss, and lower incidence of postoperative complications.

Key words: Endometrial cancer, Sentinel lymph node biopsy, Pathological ultrastaging, Systematic lymphadenectomy
图1 子宫内膜癌患者纳入流程注：前哨淋巴结活检(sentinel lymph node biopsy，SLNB)；系统性淋巴结切除(systematic lymphadenectomy，SLD)
表1 两组子宫内膜癌患者倾向性匹配前基线资料
组别 例数 年龄(岁，±s) 体质量指数(kg/m2, ±s) FIGO分期[期，M(P25，P75)] 手术史(例，有/无)
SLNB组 43 49.256±8.449 25.504±4.677 1(1，1) 17/26
SLD组 509 52.597±8.131 24.664±3.942 1(1，2) 175/334
统计值   t＝2.580 t＝－1.321 Z＝－2.660 χ2＝0.464
P值   0.010 0.187 0.008 0.496
标准化差异   －0.395 5 0.179 5 －1.108 4 0.105 4
表2 两组子宫内膜癌患者倾向性匹配后基线资料
组别 例数 年龄(岁，±s) 体质量指数(kg/m2, ±s) FIGO分期[期，M(P25，P75)] 手术史(例，有/无)
SLNB组 41 50.098±7.651 25.516±4.600 1(1，1) 16/25
SLD组 82 50.463±7.298 24.882±4.548 1(1，1) 31/51
统计值   t＝0.258 t＝－0.727 Z＝－0.537 χ2＝0.017
P值   0.797 0.469 0.591 0.896
标准化差异   －0.043 3 0.135 8 0.109 8 0.024 9
表3 两组子宫内膜癌患者一般资料
项目 SLNB组(41例) SLD组(82例) 统计值 P值
年龄(岁，±s) 51.0±7.7 51.5±7.6 t＝0.258 0.797
体质量指数(kg/m2, ±s) 26.4±5.0 25.7±5.7 t＝0.727 0.469
生育史[例(%)]     χ2＝0.523 0.581
  0次 4(9.8) 4(4.9)    
  1～2次 33(80.5) 58(70.7)    
  >2次 4(9.8) 20(24.4)    
盆腹腔手术史[例(%)] 16(39.0) 26(31.7) χ2＝0.017 0.896
FIGO分期[例(%)]     χ2＝0.503 0.591
  ⅠA 33(80.5) 69(84.1)    
  ⅡB 5(12.2) 9(11.0)    
  Ⅱ 2(4.9) 2(2.4)    
  ⅢA 0(0.0) 1(1.2)    
  ⅢB 0(0.0) 0(0.0)    
  ⅢC1 1(2.4) 1(1.2)    
分级[例(%)]     χ2＝1.907 0.059
  G1 33(80.5) 52(63.4)    
  G2 7(17.1) 23(28.0)    
  G3 1(2.4) 7(8.6)    
表4 两组腹腔镜子宫内膜癌全面分期手术患者围手术期相关情况
观察指标 SLNB组(41例) SLD组(82例) 统计值 P值
手术时间(min, ±s) 128.0±38.2 146.7±57.7 t＝2.131 0.035
术中出血量(ml, ±s) 114.2±82.0 155.2±87.9 t＝2.498 0.014
术中并发症[例(%)] 0(0.0) 0(0.0)    
淋巴结阳性[例(%)] 1(2.4) 1(1.2) χ2＝0.501 0.557
留置引流时间(d, ±s) 1.4±1.4 2.9±1.5 t＝0.893 0.210
术后24 h内肛门排气[例(%)] 16(39.0) 23(28.0) χ2＝1.472 0.145
术后住院时间(d, ±s) 5.6±2.9 6.4±2.5 t＝1.440 0.152
术后并发症[例(%)] 0(0.0) 1(1.2) χ2＝2.042 0.048
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