非小细胞肺癌30例术中应用^(99m)Tc标记前哨淋巴结的临床观察  

Application of technetium-99m sulfur colloid to detection of sentinel lymph nodes in non-small cell lung cancer

作　　者：王述民[1] 侯维平[1] 陈宪英[2] 童向东[1] 刘博[1] 许世广[1] 杨雪鹰[1] 滕洪[1] 高昕[1] 

机构地区：[1]解放军沈阳军区总医院胸外科,辽宁沈阳110016 [2]解放军沈阳军区总医院核医学科,辽宁沈阳110016

出　　处：《临床军医杂志》2010年第4期489-491,共3页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金资助项目(20082072)

摘　　要：目的探讨非小细胞肺癌术中应用99mTc探测肺癌前哨淋巴结,以提高术中清除前哨淋巴结的准确性。方法 30例非小细胞肺癌患者,术中将99mTc硫胶体溶液在肺部肿瘤环周的4～6个部位分别注射,用便携式γ射线探测器探测肺门及纵隔各部位淋巴结的放射活性计数值。常规行肺癌肺叶切除、淋巴结清除术并行常规病理检查。结果 30例患者共清除淋巴结395枚,其中前哨淋巴结即阳性转移淋巴结112枚,阳性转移率为28.3%。前哨淋巴结的99mTc放射活性计数值为15321.85±5945.28,阴性淋巴结的计数值为8479.26±3201.37(P<0.01)。结论对于非小细胞肺癌患者,术中应用99mTc标记前哨淋巴结能够更准确地提示肺癌纵隔转移淋巴结,有效提高转移淋巴结的检出率。Objective To improve the accuracy of clearing the mediastinal lymph nodes in non-small cell lung cancer inpatients using radioactive technetium-99m sulfur colloid to detect the sentinel lymph nodes during the operation.Methods Thirty patients suffered from non-small cell lung cancer (NSCLC) were included.A dosage of 9-10 mCi (9.55±0.45 mCi) radioactive techne-tium-99m (99mTc) sulfur colloid was injected into the peritumor regions.Forty minutes after the injection,the radioactivity of the hilar and mediastinal lymph nodes was counted in vivo with a handhold gamma counter before dissection.All the dissected lymph nodes were examined postoperatively by routine HE staining and immunohistochemical staining.Results As a result,112 positive sentinel lymph nodes were identified in 395 removed lymph nodes in the operation (positive metastatic rate was 28.3% ) .The radi-oactivity count value in the positive sentinel lymph node was 15 321.85±5 945.28 compared with 8 479.26±3 201.37 in the negative lymph node (P<0.01) .Conclusion The identification of the positive sentinel lymph nodes using 99mTc sulfur colloid injection into the peri-tumor during the operation in the non-small cell lung cancer is a reliable method.It improves the accuracy of clearing the mediastinal lymph nodes and is a vivo useful approach to guide mediastinal lymph node sampling or dissection.

关 键 词：非小细胞肺癌 术中应用 99MTC标记 前哨淋巴结 临床观察 lung cancer cell sentinel LYMPH nodes detection 转移淋巴结 肺癌患者 Γ射线探测器 数值 淋巴结清除术 纵隔 阳性 胶体溶液 活性 肺叶切除 肺部肿瘤 

分 类 号：R82[医药卫生—临床医学]