直视下吲哚菁绿荧光显影在乳腺癌前哨淋巴结活检中的应用

目的探讨直视下吲哚菁绿荧光显影在乳腺癌腋窝前哨淋巴结活检中的应用。方法入组34例术前考虑临床腋窝淋巴结阴性的乳腺癌患者。全麻成功后,常规消毒铺巾后,使用2 ml注射器及22 G针头,于患侧乳腺外上象限近乳晕皮下组织内注入1%亚甲蓝1~2 ml。亚甲蓝注射10~15 min后,将吲哚菁绿1 ml(1 mg/ml),注射至乳晕边缘3点、6点、9点和12点位置皮下。使用明德脉管成像仪,行患侧乳腺外上象限区域淋巴管引流实时显像。再用科大在研直视下荧光脉管显影仪行患侧乳腺外上象限区域淋巴管引流实时显像。术中荧光显影及亚甲蓝蓝染的淋巴结均予以切除,均行石蜡切片病理学检查。结果明德显像仪淋巴管显影率为97.06%(33/34),科大在研直视下显影仪淋巴管显影率97.06%(33/34)。34例可见明显荧光浓聚,33例可见明显蓝染淋巴结,1例未见蓝染淋巴结,但术中可见荧光显影。在平均淋巴结检出数量上,科大在研直视下荧光脉管显影仪为(3.090±1.602)个,明德系统为(3.060±1.613)个,亚甲蓝染色为(3.020±1.527)个,三组间两两比较差异无统计学意义(P>0.05)。结论科大在研直视下荧光脉管成像仪的淋巴结显影效果与明德成像仪相似,且能降低手术操作的繁琐程度,有望减少手术时间,为精准外科治疗提供一个更便捷的手术导航系统。

Application of Direct Vision of Indocyanine Green Fluorescence in Sentinel Lymph Node Biopsy of Breast Cancer

Objective To investigate the application of direct vision of indocyanine green fluorescence as lymph node tracers in axillary sentinel lymph node biopsy of breast cancer.Methods After general anesthesia,2 ml syringe and 22G needle was used to inject 1%methylene blue(1~2 ml)into the subcutaneous tissue near the areola in the upper quadrant of the breast.After injection of methylene blue for 10~15 minutes,1 ml(1 mg/ml)of indocyanine green was injected subcutaneously at the 3,6,9 and 12 points of the areola margin.Using Mingde vessel imager,real-time imaging of lymphatic drainage in the upper quadrant of the breast was performed.Then,under the direct vision,the real-time imaging of lymphatic drainage in the external upper quadrant of the affected breast was performed under direct fluorescent lymphoscintigraphy.The lymph nodes stained by fluorescein and methylene blue were resected,and paraffin pathological examination was performed for them.Results The visualization rate of lymphatics was 97.1%(33/34)in Mingde imaging system,and 97.1%(33/34)in the direct fluorescent lymphoscintigraphy.34 cases showed obvious fluorescence concentration,33 cases showed obvious blue stained lymph nodes,1 case showed no blue stained lymph nodes.In terms of the average number of lymph nodes detected,there were 3.090±1.602 in the direct fluorescent lymphoscintigraphy,3.060±1.613 in Mingde system and 3.020±1.527 in methylene blue staining.There was no significant difference between two groups(P>0.05).The effect of lymph node visualization of fluorescent vessel imager under direct vision is similar to that of Mingde imager,and it can reduce the complexity of operation,hopefully reduce operation time,and provide a more convenient operation navigation system for precise surgical treatment for the detection of sentinel lymph node.