中低位直肠癌前哨淋巴结定位活检的可行性研究  

Study on the Feasibility of Sentinel Lymph Node Biopsy for Midst-low Position Rectal Cancer

作　　者：童汉兴[1] 陆巍[1] 唐翠斌[1] 郑嘉佳[1] 练士贤[1] 黄倩[1] 何国杰[1] 赵纲[1] 张勇[1] 朱隽[1] 陆维祺[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中国临床医学》2009年第1期80-82,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:通过联合纳米炭(carbon nanoparticles,CNP)和99mTc-硫胶体(99mTc sulfur colloid,TSC)对腹膜返折上、下方直肠癌前哨淋巴结(sentinel lymph node,SLN)定位活检,探讨中低位直肠癌SLN活检的可行性。方法:25例直肠癌患者(10例癌位于腹膜返折上、15例癌位于腹膜返折下),术中于瘤周浆膜下或粘膜下注射CNP和TSC行SLN定位活检。对检出的SLN行常规HE染色病理学检查,若为阴性则加行细胞角蛋白20(cytokratin 20,CK20)免疫组化检测,并比较两组检出率、灵敏度的差异。结果:5例直肠癌患者SLN的检出率为96%(24/25),每例检出1～4个SLN,平均2个。SLN判断结直肠癌区域淋巴结转移状态的灵敏度为91.67%,假阴性率为11.77%。两组检出率及灵敏度均无统计差异。在15例常规HE染色检测SLN阴性的患者中有3例CK20免疫组化检测阳性。结论:中低位直肠癌SLN活检是可行的。应依据肿瘤部位的不同分别选用粘膜下或浆膜下注射CNP和TSC行直肠癌前哨淋巴结活检。Objective：To evaluate the feasibility of sentinel lymph node （SLN）biopsy （SLNB） for midlow position rectal cancer. Methods：Twenty-five patients who underwent radical resection of a primary rectal cancer were considered for inclu sion. During resection, SLN mapping was performed with carbon nanoparticles （CNP） and ^99mTc sulfur colloid （TSC）. All lymph nodes were stained with HE. SLNs, when negative by routine HE staining, were further analyzed with cytokratin 20 immunohistochemistical（CK20- IHC）staining. Results： SLNs were detected in 24 of 25 patients with an overall successful detection rate of 96 %. The number of SLNs ranged from 1 to 4, with a mean value of 2 per case. As a whole, the diagnostic sensitivity and false- negative rate were 91.67%, and 11.77%, respectively. Between extraperitonea and intraperitonea rectal cancers, there were no statistical difference in successful detection rate, diagnostic sensitivity and false- negative rate. In 15 patients with SLNs being negative by HE staining, there were 3 patients detected micrometastases by CK20 - IHC. Conclusion： SLNB for mid- low position rectal cancer is feasible. Rectal cancer SLNB should adopt different mapping method according to different lesion position.

关 键 词：直肠肿瘤 前哨淋巴结 纳米炭颗粒 99mTc-硫胶体 

分 类 号：R735.37[医药卫生—肿瘤]