用γ探测仪定位法检测胃癌前哨淋巴结  

Radio-guided and γ probe-directed sentinel lymph node detection for gastric cancer

作　　者：程黎阳[1] 尹吉林[2] 陈晓东[3] 谢正勇[1] 

机构地区：[1]广州军区广州总医院普通外科,510010 [2]广州军区广州总医院核医学科,510010 [3]广州军区广州总医院病理科,510010

出　　处：《中华核医学杂志》2005年第4期203-205,i0003,共4页Chinese Journal of Nuclear Medicine

基　　金：广东省自然科学基金资助项目(032204)

摘　　要：目的探讨胃癌前哨淋巴结(SLN)概念及用γ探测仪定位法检测胃癌SLN的可行性和准确性。方法经胃镜于胃癌病灶周围黏膜下注入99Tcm-硫胶体(SC),先行腹部γ照相,剖腹后用γ探测仪扫描手术野,将放射性计数高于本底10倍以上的淋巴结视为SLN,并对常规病理检查为转移阴性的SLN进行细胞角蛋白免疫组织化学(IHC)染色。结果21例胃癌中19例检出SLN。SLN检出范围1-4个/例,平均2.6个/例;大部分(77.5%)的SLN出现在N1淋巴区域,2例胃癌的SLN仅出现在N2;SLN的转移率明显高于非SLN(63.5%vs19.7%,X2=5.14,P<0.05);SLN诊断胃癌区域淋巴结转移状态的准确性为89.5%,假阴性率为13.3%;经IHC染色使1例胃癌患者的淋巴结病理分期得到上调。结论SLN概念适用于胃癌;用γ探测仪定位法检测胃癌SLN可较准确地预测胃癌区域淋巴结转移状态。Objective To investigate the feasibility and the accuracy of radio-guided and γ probedirected sentinel lymph node（SLN） detection for gastric cancer. Methods 21 patients undergoing curative resection of primary gastric cancer with extended lymph node dissection were included in this study. ^99Tc^msulfur colloid （SC） was injected submucosally in four quadrants of the primary lesion, using an endoscopic puncture needle. 2 -4 h later, hot spots were identified by lymphoscintigraphy with SPECT, and γ probe was used intraoperatively to locate SLNs reached 10 times more radioactivity than surrounding tissue. The specimens were analyzed in the usual fashion. Nodes with high radioactivity that were negative by hematoxylin and eosin （HE） staining were further examined by immunostaining. Results SLNs were identified in 19 （90%） of 21 patients. 49 SLNs were detected with a mean number of 2.6 nodes per case, ranged from 1 to 4. Most （77.5%） of SLNs were found in Nl area, but 2 cases were in the N2 area without Nl involvement. The incidence of metastasis was significantly higher in SLN than in non-SLN （63.5% vs 19.7%, x^2 = 5. 14, P 〈 0.05 ）. The accuracy of the SLN metastatic status in diagnosis of the regional lymph node status was 89. 5%. The false-negative rate was 13.3%. With immunohistochemical staining, lymphatic pathologic staging in 1/4 patients was upstaged. Conclusion SLN concept is feasible for gastric cancer; radio-guided and γ probe-directed SLN detection is an accurate diagnostic procedure for detecting lymph node metastasis in patients with gastric cancer.

关 键 词：胃肿瘤 淋巴转移 胶体 Γ探测 前哨淋巴结 胃癌患者 Γ探测仪 定位法 检测 ^99Tc^m-硫胶体 

分 类 号：R735.2[医药卫生—肿瘤]