CAJ | 학술논문

目的探讨纳米炭和亚甲蓝分别联合核素示踪法在腔镜乳腺癌前哨淋巴结活组织检查(简称活检)中的临床应用效果。方法选取2014年3月至2014年12月在第三军医大学附属西南医院诊断为乳腺癌的80例患者,随机分为两组,行腔镜下乳腺癌前哨淋巴结活检手术。其中采用纳米炭联合核素示踪前哨淋巴结组(简称纳米炭组)40例,采用亚甲蓝联合核素示踪前哨淋巴结组(简称亚甲蓝组)40例。分析比较两组术后前哨淋巴结检出率、阳性率及各种术后并发症。淋巴结数目用xˉ±s表示,行独立样本t检验；淋巴结阳性率及术后并发症行χ2检验或Fisher确切概率检验。结果纳米炭组前哨淋巴结检出率为100%(40/40),亚甲蓝组前哨淋巴结检出率为97.5%(39/40)；两组平均检出前哨淋巴结数量分别为纳米炭组(3.4±1.5)枚和亚甲蓝组(3.2±1.5)枚；前哨淋巴结阳性率分别为纳米炭组32.5%(13/40)和亚甲蓝组25.6%(10/39,本组有1例未检测出SLN)。两组上述各指标之间比较差异均无统计学意义(SLN阳性率：χ2=0.450,P=0.502；平均SLN检出数：t=0.984,P=0.326)。纳米炭组非前哨淋巴结检出116枚,平均为(3.2±1.1)枚(2~5枚),其中黑染57枚,染色率49.1%,亚甲蓝组非前哨淋巴结检出97枚,平均(2.8±1.1)枚(1~5枚),蓝染26枚,染色率26.8%,两组非前哨淋巴结平均每例检出数目及染色率比较差异有统计学意义(t=2.632,P=0.009和χ2=11.079,P=0.001)。术后腋下积液发生情况两组之间比较差异无统计学意义(P=0.660)。结论纳米炭和亚甲蓝分别联合核素示踪法在腔镜乳腺癌前哨淋巴结活检术临床应用中均能到达良好的示踪效果,检出率高,手术创伤小,术后瘢痕小、并发症少,纳米炭有助于检出更多的非前哨淋巴结,可能更适合作为腋窝淋巴结清扫术的示踪剂。
목적탐토납미탄화아갑람분별연합핵소시종법재강경유선암전초림파결활조직검사(간칭활검)중적림상응용효과。방법선취2014년3월지2014년12월재제삼군의대학부속서남의원진단위유선암적80례환자,수궤분위량조,행강경하유선암전초림파결활검수술。기중채용납미탄연합핵소시종전초림파결조(간칭납미탄조)40례,채용아갑람연합핵소시종전초림파결조(간칭아갑람조)40례。분석비교량조술후전초림파결검출솔、양성솔급각충술후병발증。림파결수목용xˉ±s표시,행독립양본t검험；림파결양성솔급술후병발증행χ2검험혹Fisher학절개솔검험。결과납미탄조전초림파결검출솔위100%(40/40),아갑람조전초림파결검출솔위97.5%(39/40)；량조평균검출전초림파결수량분별위납미탄조(3.4±1.5)매화아갑람조(3.2±1.5)매；전초림파결양성솔분별위납미탄조32.5%(13/40)화아갑람조25.6%(10/39,본조유1례미검측출SLN)。량조상술각지표지간비교차이균무통계학의의(SLN양성솔：χ2=0.450,P=0.502；평균SLN검출수：t=0.984,P=0.326)。납미탄조비전초림파결검출116매,평균위(3.2±1.1)매(2~5매),기중흑염57매,염색솔49.1%,아갑람조비전초림파결검출97매,평균(2.8±1.1)매(1~5매),람염26매,염색솔26.8%,량조비전초림파결평균매례검출수목급염색솔비교차이유통계학의의(t=2.632,P=0.009화χ2=11.079,P=0.001)。술후액하적액발생정황량조지간비교차이무통계학의의(P=0.660)。결론납미탄화아갑람분별연합핵소시종법재강경유선암전초림파결활검술림상응용중균능도체량호적시종효과,검출솔고,수술창상소,술후반흔소、병발증소,납미탄유조우검출경다적비전초림파결,가능경괄합작위액와림파결청소술적시종제。
Objective To explore the application effect of 99 Tcm-sulfur colloid combined with carbon nanoparticles or methylene blue in endoscopic sentinel lymph node biopsy ( ESLNB) in breast cancer patients. Methods From March 2014 to December 2014, a total of 80 breast cancer patients were randomly divided into two equal groups ( n=40 ) . Both groups underwent ESLNB. One group received carbon nanoparticles plus 99Tcm-sulfur colloid tracing sentinel lymph node (SLB) (nanocarbon group) and the other group received methylene blue plus 99Tcm-sulfur colloid tracing SLB (methylene blue group). After operation, the detection rate of SLB, positive rate and postoperative complications were compared between two groups. Measurement data were expressed as xˉ±s and processed by independent sample t test. The count data were compared by χ2 test or Fisher exact test. Results The detection rate of sentinel lymph nodes was 100% ( 40/40 ) in nanocarbon group and 97. 5% ( 39/40 ) in methylene blue group respectively. The mean number of detected sentinel lymph nodes per patient was 3. 4 ± 1. 5 in nanocarbon group and 3. 2 ± 1. 5 in methylene blue group respectively, indicating no significant difference between two groups (t=0. 984,P=0. 326). The positive rate of sentinel lymph nodes was 32. 5% (13/40) in nanocarbon group and 25. 6% (10/39, one did not detect the SLN) in methylene blue group respectively, indicating no significant difference between two groups (χ2 =0. 450,P=0. 502). Totally 116 non-sentinel lymph nodes were detected in nanocarbon group, mean (3. 2 ± 1. 1) per patient (range:2-5), including 57 black-stained lymph nodes (49. 1%). In methylene blue group, 97 non-sentinel lymph nodes were detected, mean (2. 8 ± 1. 1) per patient (range 1-5), including 26 blue-stained lymph nodes ( 26. 8%) . The number of detected non-sentinel lymph nodes per patient and stain rate showed significant differences between two groups(t=2. 632, P=0. 009,χ2=11. 079,P=0. 001). There was no significant difference in postoperative complication rate between two groups (P=0. 660). Conclusions Carbon nanoparticles or methylene blue combined with 99 Tcm-sulfur colloid show a beneficial tracing effect in SLNB for breast cancer patients, with the advantages of high detection rate, minimal trauma, small surgical scar and less complications. However, Carbon nanoparticles are helpful to detect non-sentinel lymph nodes, which can be useful as tracers for axillary lymph node dissection.