^(99m)Tc标记抗CEA单抗C50在直肠癌TME术中的应用  

The application of ^(99m)Tc labeled monoclonal antibody C50 in total mesorectal excision

作　　者：王震[1] 田素礼[1] 康悦[1] 张日平[1] 张好刚[1] 

机构地区：[1]哈尔滨医科大学附属第二临床医学院普外科,黑龙江哈尔滨150086

出　　处：《中国实验诊断学》2005年第3期403-405,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨99mTc标记的单克隆抗体(monoclonalantibody,McAb)C50在直肠癌手术中的应用价值。方法将99mTc标记抗CEA单抗C50在直肠镜直视下注射于32例直肠癌患者癌周粘膜下;给药后次日行全直肠系膜切除术(to-talmesorectalexcision,TME),术中使用手持式γ探测仪(gamma-detectingprobe,GDP)对肿瘤、区域淋巴结、手术切缘、直肠系膜等靶部位(target,T)进行放射性检测,以正常肠壁为对照本底(normaltissue,NT),以T/NT≥3为判别直肠系膜、肠壁浸润及淋巴结转移的标准;全部标本行病理学检验;病理学阴性的淋巴结标本进行免疫组化染色(S-P法)寻找微转移灶。结果GDP探测判别肿瘤的灵敏度为93·75%,判别切缘的特异度为95·15%。判别淋巴结的灵敏度及特异度分别为93·10%、90·10%,与临床判别相比差异有显著性意义(P<0·05)。免疫组化证实RID能够检出部分病例中常规病理检验未发现的淋巴结微转移灶。结论应用99mTc标记抗CEA单抗C50对直肠癌原发病灶及转移灶进行放射免疫检测,有较高的特异性和亲和力,可准确区分肿瘤及正常组织并探测出微小转移病灶,并从肿瘤免疫学方面证实了TME的科学性。Objective To evaluate ^(99m)Tc labeled monoclonal antibody(McAb) C50 in radioimmunoguidedsurgery(RIGS) for patients with rectal cancer. Methods ^(99m)Tc McAb-C50 was injected submucously intopericancerous site under rectoscope in 32 patients. Intraoperative radioimmunodetection on targets(T) of tumors, regional lymph nodes and incisional margins, was carried out using a portable gamma-detecting probe. The T/NT ratio of 3∶1 was taken as the lowest threshold value of positivity for primary lesions, wall infiltration and lymph node metastasis. Lymph nodes were stained immunohistochemically for micrometastasis. Results The sensitivity for primary lesions was 93.75%. The specificity for tumor margin was 95.15%. For lymphatic metastasis, the sensitivity of RIGS was 93.10%, and the specificity was 90.10%(all P<0.05, compared with that not using RIGS). Immunohistochemistry verified the existence of lymphatic micrometastasis in the RIGS positive but histology-negative lymph nodes. Conclusion RIGS for rectal cancer using anti-CEA McAb C50 submucosally enable the surgeon to define lymphatic metastasis, and may be a significant aid to surgeon in performing personalized operation.

关 键 词：直肠肿瘤 单克隆抗体 全直肠系膜切除术 放射免疫导向手术 

分 类 号：R735.37[医药卫生—肿瘤]