术中美蓝染色及抗细胞角蛋白20检测淋巴结及其微转移在直肠癌患者中的临床应用  

Clinical usage of lymph node screening by methylene blue staining and its micrometastasis by immunohistochemistry with anti-CK20 in rectal cancer patients

作　　者：夏利刚[1] 左敏[2] 潘凯[1] 王东[1] 杨小东[1] 陈小春[1] 钟克力[1] 

机构地区：[1]广东省深圳市人民医院胃肠外科,518002 [2]广东省深圳市人民医院病理科,518002

出　　处：《中华胃肠外科杂志》2004年第5期394-396,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨术中经直肠上动脉注射美蓝行直肠系膜及淋巴结染色检测淋巴结及其微转移方法的临床意义。方法对30例行根治性手术治疗的直肠癌患者,术中经直肠上动脉插管注射美蓝6ml(美蓝染色组),使直肠系膜及各组淋巴结染色以统计淋巴结数目,同时行抗细胞角蛋白20(CK20)免疫组织化学(免疫组化)染色,检测其微转移情况;并与同期32例行直肠癌根治术患者术中常规手检法(常规手检组)检出的淋巴结数目进行对比。结果美蓝染色组肠旁淋巴结、肠系膜淋巴结、肠系膜根部淋巴结检出数目均明显多于常规手检组(P均=0.000)。美蓝染色组淋巴结常规病理检查阴性者,经CK20免疫组化染色,其转移阳性率增加17.7%;14例DukesB期患者(46.7%)经淋巴结CK20免疫组化染色需重新确定为DukesC期,11例患者(36.7%)出现跳跃淋巴结微转移现象。结论术中经直肠上动脉注射美蓝行淋巴结染色能提高淋巴结检出率。对常规病理检查阴性的淋巴结行CK20免疫组化染色检查其微转移灶,能提高淋巴结阳性检出率,使病理分期更准确。Objective To investigate lymph node screening by intraoperative methylene blue staining and lymph nodes micrometastasis by immunohistochemistry with anti CK20 in rectal cancer patients. Methods Methylene blue was injected intraoperatively into superior rectal artery to stain the lymph nodes in the mesorectum of 30 rectal cancer patients. The numbers of lymph nodes detected by lymph node screening were compared with those macroscopically detected in routine radical rectal resection performed in 32 patients during the same period. Immunohistochemistry with anti CK20 was used to detect lymph node micrometastasis in methylene blue staining group. Results The numbers of lymph nodes beside the intestine, in the mesorectum and around the root of the mesorectum in lymph node screening group were significantly higher than those in routine operation group(P=0.000). Immunohistochemistry with anti CK20 in methylene blue staining group raised the positive rate of lymph node by 17.7%. Fourteen patients with Dukes B stage estimated with routine pathological examination had to change their stages to Dukes C(46.7%). Eleven patients had skip lymph node micrometastasis. Conclusions Lymph node screening with methylene blue staining can increase the detectable rate of lymph nodes. Immunohistochemistry with anti CK20 can increase the positive rate of lymph nodes and the accuracy of clinical stages.

关 键 词：淋巴结 术中 患者 美蓝染色 CK20 临床应用 微转移 常规 数目 准确 

分 类 号：R735.37[医药卫生—肿瘤]