放射导向手术在食管癌转移淋巴结检测的临床价值  

Clinical Application of Intraoperative Radioguidance Technique for Detection of Metastatic Lymph Nodes in Patients with Esophageal Carcinoma

作　　者：卢敏[1] 胡永校[1] 

机构地区：[1]医科大学附属一院胸外科,研究生110001

出　　处：《放射免疫学杂志》2008年第6期486-488,共3页Journal of Radioimmanology

基　　金：辽宁省博士启动基金:食管癌放射免疫导向手术的研究(项目标号:20041042)

摘　　要：目的:采用放射导向手术检测经99mTc-MIBI标记的食管癌病人30例,食管平滑肌瘤及贲门失弛缓症病人10例,探讨对食管癌转移淋巴结检测的临床价值。方法:用放射导向手术探测病灶,胸内和腹部淋巴结及切除的标本,术后对常规病理为阴性(即假阳性)的淋巴结,进行连续切片,HE染色,显微镜下观察。然后计算及统计学处理。结果:30例病人当中,廓清淋巴结694枚,转移者共有148枚。淋巴结转移以局部转移多见;其次为连续性转移与跳跃性转移,多向性转移最为少见。用放射导向手术探测淋巴结的灵敏度为100,特异度96.3,准确率98.9。结论:淋巴结转移情况是影响食管癌病人预后的重要因素。放射导向手术不仅能检测出微小的转移淋巴结,而且术中就能准确地判断肿瘤的临床分期,指导手术廓清的进行。使食管癌手术的根治度迈向一个新的高度。Objective To investigate the clinical usefulness of intraoperative radioguidance technique for detection of metastatic lymph nodes in patients with esophageal cancer. Methods Intravenous ^99Tc - MIBI solution （740MBq） was administered 30rain be-for operation to 30 patients with esophageal squamous carcinoma and 10 patients with benign esophageal disorders （leiomyoma, cardiac achlasia）, Intraoperatively, the operative field was screened with r-probe to detect the radioacitivity of various structures, activity over twofold of the basal value （ over normal esophagus） was taken to be positive （ presence of malignarcy）. All the lymph nodes re- moved were screened with r-camera post operatively. Serially - sectioned with immuno - histochemistry staining pathologic examina- tion were pofformed in radiologically positive but conventionally pathologically neagtive nodes （ n = 13 ） to detect any false positive case. Serial section with IHC stain was also performed in the 546 radiologicaUy negative nodes to detect any false negative case. Results Among all the 694 nodes removed during operation, 135 nodes proved to be beth radiologically and conventionally pathologically positive. In the 13 radiologically positive but conventionally pathologically negative nodes, serial section with IHC staining reveaUed presence of microscopic metastasis in 6 nodes （r probe false positive 7 cases）. No false negativity was detected in the 546 radiological- ly negative nodes with IHC technic. Thus sensitivity of the radioguidance technique was 100%, specificity was （95.3%） with an ac- curacy of 98.9%. Conclusion Intraoperative radioguidance technique is feasible, highly sensitive, and highly specific with high accuracy and zero false negativeness.

关 键 词：食管癌 转移淋巴结放 射导向手术 

分 类 号：R734.205[医药卫生—肿瘤] R735.2[医药卫生—临床医学]