CAJ | 학술논문

目的：探索99Tcm 标记的右旋糖苷结合γ射线探测仪在淋巴结显像中的用药规律和前哨淋巴结活检的准确性；探讨前哨淋巴结活检在恶性黑色素瘤早期转移诊治中的临床意义。方法2012年3月至2013年5月，我科收治35例肢端恶性黑色素瘤患者，其中手部8例、足部27例。所有病灶Breslow厚度均＞1 mm，且无临床及影像学淋巴结转移的证据。除外淋巴结已有转移的患者。术前4～6 h 在病灶周围注射1～2 mCi的99Tcm标记的右旋糖苷，注射后30 min、2、4 h行核素显像，获得前哨淋巴结的显像图。然后在麻醉下切取前哨淋巴结，术中用γ射线探测仪帮助定位和切取前哨淋巴结。术后淋巴结行3 mm一层的切片，行HE 染色和 HMB-45，S-100，Melan-A 免疫组化染色。前哨淋巴结活检结果阳性的行局部淋巴结清扫。结果核素注射后4 h前哨淋巴结显像稳定。27例足部黑色素瘤患者前哨淋巴结中有7例窝及腹股沟均显像，其余20例仅腹股沟淋巴结显像；8例手部黑色瘤患者中有2例滑车上及腋窝淋巴结均显像，其余6例仅腋窝淋巴结显像。35例均检出前哨淋巴结，前哨淋巴结检出率为100%。前哨淋巴结的个数为1～3个。5例患者的前哨淋巴结病理检查发现有转移，阳性率为14.3%。此5例均行淋巴结清扫术。结论用99Tcm标记的右旋糖苷作为显像剂、术中应用γ射线探测仪的前哨淋巴结活检技术在肢端黑色素瘤中是一种可靠的技术。
목적：탐색99Tcm 표기적우선당감결합γ사선탐측의재림파결현상중적용약규률화전초림파결활검적준학성；탐토전초림파결활검재악성흑색소류조기전이진치중적림상의의。방법2012년3월지2013년5월，아과수치35례지단악성흑색소류환자，기중수부8례、족부27례。소유병조Breslow후도균＞1 mm，차무림상급영상학림파결전이적증거。제외림파결이유전이적환자。술전4～6 h 재병조주위주사1～2 mCi적99Tcm표기적우선당감，주사후30 min、2、4 h행핵소현상，획득전초림파결적현상도。연후재마취하절취전초림파결，술중용γ사선탐측의방조정위화절취전초림파결。술후림파결행3 mm일층적절편，행HE 염색화 HMB-45，S-100，Melan-A 면역조화염색。전초림파결활검결과양성적행국부림파결청소。결과핵소주사후4 h전초림파결현상은정。27례족부흑색소류환자전초림파결중유7례와급복고구균현상，기여20례부복고구림파결현상；8례수부흑색류환자중유2례활차상급액와림파결균현상，기여6례부액와림파결현상。35례균검출전초림파결，전초림파결검출솔위100%。전초림파결적개수위1～3개。5례환자적전초림파결병리검사발현유전이，양성솔위14.3%。차5례균행림파결청소술。결론용99Tcm표기적우선당감작위현상제、술중응용γ사선탐측의적전초림파결활검기술재지단흑색소류중시일충가고적기술。
Objective To explore how to use the technetium-99m ( 99Tcm ) dextran and the gamma-ray detector in the sentinel lymph node mapping ( SLNM ) and the accuracy of SLN biopsy, and to investigate the clinical value of SLN biopsy in the early diagnosis and treatment of malignant melanoma metastasis. Methods From March 2012 to May 2013, 35 patients with malignant melanoma in the extremities were admitted. There were 8 cases in the hands and 27 cases in the feet. The Breslow thickness of all primary lesions were more than 1 mm, and no lymph node metastasis was found clinically and radiographically. The patients with lymph node metastasis were ruled out. All patients received intradermal injection of 1-2 millicurie ( mCi ) of 99Tcm dextran around the lesions at 4-6 hours before the operation. Radionuclide imaging was performed at 30, 120, 240 minutes after the injection to achieve the SLN images. And the SLN was excised under anesthesia. During the operation, the gamma-ray detector was used to help identify and excise the SLN. After the operation, a piece of 3 mm SLN was sliced, and then the HE dying, Melanoma Marker ( HMB-45 ), S-100 and Melan-A immunohistochemical staining were performed. The patients with the positive SLN accepted lymph node dissection locally. Results The SLN images were clear at 4 hours after the injection. Seven patients had popliteal and inguinal images among the 27 patients with melanoma in the feet, and the remaining 20 patients had inguinal images. Two out of 8 patients with melanoma in the hands had epitrochlear and axillary lymph node images, and the remaining 6 patients only had axillary lymph node images. The SLN was detected in all 35 patients, and the rate was 100%. The number of SLN was 1-3. The pathologic examination revealed that 5 patients had SLN metastasis, and the positive rate was 14.3%. All 5 patients underwent lymphadenectomy. Conclusions The SLN biopsy is a reliable technique for the patients with melanoma in the extremity with the 99Tcm dextran as the imaging agent, and the gamma-ray detector is used during the operation.