胰头癌淋巴结微转移与淋巴结分组关系的初步探讨  

The study of lymph node micrometastasis in cancer of the head of pancreas, and its relationship with lymph node grouping and stationing

作　　者：金忱[1] 张波[1] 傅德良[1] 龙江[1] 徐近[1] 蒋永剑[1] 唐峰[2] 王虹[2] 虞先浚[1] 倪泉兴[1] 

机构地区：[1]复旦大学胰腺病研究所复旦大学附属华山医院外科,上海200040 [2]复旦大学附属华山医院病理科,上海200040

出　　处：《外科理论与实践》2008年第5期431-434,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨胰头癌淋巴结转移和微转移的分布特点,分析微转移与淋巴结分组、分站的关系,由此为确定胰十二指肠切除时的淋巴清扫范围提供理论依据。方法:以手术显微镜法分区域、完整收集并检出20例因胰头癌作区域性胰十二指肠切除术和扩大淋巴结清扫病例标本中的淋巴结,以苏木精-伊红染色和细胞角化蛋白(CK)染色检测淋巴结转移和微转移的发生。结果:在20例677枚淋巴结中,苏木精-伊红染色发现13例87枚淋巴结发生转移,CK染色发现57枚淋巴结存在微转移,总淋巴结转移病例数为16例(80%);微转移发生频率较高的为13组18.9%、14组14.2%、16组9.3%、11组8.6%、17组8.3%、9组4.2%、8组3.7%及12组3.0%;总淋巴结转移发生率较高的是:13组37.4%(46/123)、17组28.3%(13/46)、14组26.4%(37/140)、16组17.0%(18/106)、8组16.1%(10/62)和6组14.7%(5/34)。结论:胰头癌的淋巴结转移发生率甚高,微转移检测影响淋巴结的分组和分站,有助于明确临床分期;行胰头癌根治术时,应注重第13、17、14、16、8和6组淋巴结的清扫。Objective To investigate the status of lymph node（LN） metastasis and micrometastasis in cancer of the head of pancreas, and thereby its relatiouship with LN grouping and stationing; thus providing theoretical evidence of the extent of radical LN resection in the surgical procedure for cancer of the head of pancreas. Methods Twenty patients with cancer of the head of pancreas undergoing pancreaticoduodenectomy with extended LN dissection were collected into the study. All the LNs in the specimens were identified by the help of surgical microscope, and were diagnosed metastatic by histological examination with HE staining and micrometastatic CK（AE1/AE3） staining. Results According to HE staining, 13 of 20 patients and 87 of a total of 677 LNs were identified metastatic, and 57 of the 590 HE negative LNs were noted to be micrometastatic by CK staining. Sixteen of the 20 （80%） patients were found with lymphatic metastasis. Lymphatic micrometastasis were usually found in Groups 13（18.9%）, 14（14.2%）, 16（9.3%）, 11 （8.6%）, 17（8.3%）, 9（4.2%）, 8（3.7%） and 12（3.0%）. Combined with the examination by HE staining, the lymphatic metastasis were usually found in the Groups 13（37.4%）, 17（28.3%）, 14（26.4%）, 16（17.0%）, 8（16.1%） and 6（14.7%）. Conclusions The incidence of LN metastasis in cancer of the head of pancreas is very high. The detection of lymphatic micrometastasis could influence the LN grouping and stationing, and is helpful for the exact clinical staging. More attention should be paid to Groups 13, 17, 14, 16, 8 and 6 LNs during the radical resection for cancer of the head of pancreas.

关 键 词：胰腺肿瘤 淋巴转移 微转移 淋巴结切除术 

分 类 号：R735.9[医药卫生—肿瘤]