摘要
目的探讨采用多光谱分光融合外科手术引导系统(MGS)在阴茎癌前哨淋巴结活检中的临床价值。方法回顾性分析2017年4月至2018年4月我院采用MGS进行阴茎癌前哨淋巴结活检的7例患者的临床资料。年龄62-78岁,平均65岁。肿物位于阴茎头或冠状沟,均<T3期;3例腹股沟淋巴结可触及,4例不能触及,但超声检查直径>1cm。所有患者均在阴茎肿瘤近端正常皮肤下或皮内12、4、6和9点处,采用1ml注射器在各点注射吲哚菁绿溶液0.25ml(2.5mg/m1),共1ml,立刻将成像探头对准注射点,观察MGS显示器上荧光影像的动态变化。MGS显示的图像包括可见光图像、荧光图像和融合图像,融合图像为绿色伪彩。按照图像的动态特征,荧光影像依次包括注射点部、阴茎体部、耻骨联合部、腹股沟部和前哨淋巴结部5个部分。结果7例患者14侧,除1侧未见显影外,其余13侧显影良好。显影良好的13侧,在注射后15min左右,其他部位荧光逐渐消失,腹股沟区荧光影像逐渐浓聚固定,为前哨淋巴结体外确定位点。切开该处皮肤后即刻看到荧光强度更强的淋巴结样组织,与周围组织有明确的边界,沿此边界分离、结扎、切除,并送病理检查;淋巴样组织切除后,仍有3侧有残余荧光斑点,进一步切除。未显影的1侧,未找到淋巴结。术后病理证实13侧按照荧光影像体外定位、体内示踪的荧光显影组织为淋巴结,符合率为100%;3侧有残余荧光的组织,病理证实为淋巴管。结论MGS辅助术中荧光成像,显著提高医生的视觉深度,能够实时、动态、准确地体外定位和体内示踪阴茎癌前哨淋巴结。
Objective To explore the method and clinical value of sentinel lymph node biopsy for penile carcinoma guided by multispectral separate-merge guided surgery device (MGS).Methods The clinical data of 7patients with sentinel lymph node biopsy of penile cancer guided by MGS from April 2017 to April 2018 were analyzed retrospectively at First Hospital of Shanxi Medical University.They were 62-78 years old,with an average age of 65 years.All of carcinoma was located in the glans or coronal sulcus, which diameter was 1.0-3.5 cm,with an average of 2.5cm.Three cases of inguinal lymph nodes could be non-palpable and the others palpable.All patients were injected 0.25 ml (2.5mg/ml)of indocyanine green solution with 1 ml syringe at 12,4,6 and 9 points in the proximal normal skin of penile tumors. Immediately,the imaging probe was aligned with the injection point to observe the dynamic changes of fluorescence image on MGS display.Results There were 14 sides of groin in 7patients,except for 1side without images,other 13 sides developed well.The images displayed by MGS include visible image, fluorescent image and merged image,and the merged image was green pseudo color.According to the dynamic changes of the image,it could be divided into five parts:injection point,penile body,pubic symphysis,inguinal region and sentinel lymph node.In 13 well-developed sides,fluorescence gradually disappeared in other parts about 15 minutes after injection,and the location of sentinel lymph nodes was determined in vitro by gradually consolidating and fixing the fluorescence images in the inguinal region.The lymph node-like tissue with strong fluorescence intensity was observed immediately after the skin incision. There was a clear boundary between the lymph node-like tissue and the surrounding tissue.Along this boundary,lymph nodes were separated,ligated,excised.No lymph nodes were found on the undetected side.Postoperative pathology confirmed that lymph nodes were located by fluorescence imaging in vitro and traced by fluorescence imaging in vivo,the coincidence rate was 100%.There were residual fluorescent tissues on three sides and lymphatic vessels were removed.Conclusions MGS-assisted intraoperative fluorescence imaging could improve the doctor's visual depth so that physicians can real-time,dynamic, accurate in vitro location and in vivo tracking of sentinel lymph nodes of penile cancer.
作者
杨晓峰
张瑞
梁学志
曹晓明
马彦杰
王璟琪
薛亚洲
王东文
Yang Xiaofeng;Zhang Rui;Liang Xuezhi;Cao Xiaoming;Ma Yanjie;Wang Jingqi;Xue Yazhou;Wang Dongwen(Department of Urology,First Hospital of Shanxi Medical University,Taiyuan 030000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第12期930-934,共5页
Chinese Journal of Urology
基金
山西省重点研发专项基金(201703D321028).
关键词
阴茎癌
前哨淋巴结活检术
荧光成像
吲哚菁绿
图像引导
Penile carcinoma
Sentinel lymph node biopsy
Fluorescence image
Indocyanine green
Image guided
