胰头癌淋巴结微转移的检出及其分析  

Detection of lymph node micrometastasis in pancreatic head carcinoma

作　　者：张波[1] 龙江[1] 金忱[1] 徐近[1] 蒋永剑[1] 唐峰[2] 王虹[2] 虞先俊[1] 傅德良[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]复旦大学胰腺病研究所,复旦大学附属华山医院病理科,上海200040

出　　处：《中华胰腺病杂志》2009年第1期21-23,共3页Chinese Journal of Pancreatology

摘　　要：目的通过对胰头癌切除标本中淋巴结微转移的检测，分析淋巴结微转移对胰头癌临床分期及预后的影响，探讨其临床价值。方法以手术显微镜法完整取出20例因胰头癌行区域性胰十二指肠切除术标本中的淋巴结，常规病理检测淋巴结转移，免疫组化检测淋巴结微转移。结果20例标本中共找到677枚淋巴结，常规病理显示13例共87枚淋巴结发生转移。在病理检测阴性的590枚淋巴结中，免疫组化检测又发现3例57枚淋巴结存在微转移。常规病理结合免疫组化检测，淋巴结转移阳性患者从65％（13／20）增加到80％（16／20）；转移淋巴结的检出率从12．9％（87／677）上升到21．3％（144／677），相差显著（P〈0．05）。微转移检测使3例ⅡA期患者转为ⅡB期，有淋巴结微转移患者的1年内肿瘤转移、复发率为75％，而无微转移者的转移、复发率为25％。结论胰头癌淋巴结微转移的检出有助于肿瘤分期的确定和预后的判断。Objective To detect the lymph node micrometastasis in resected pancreatic head carcinoma, to investigate the role of lymphatic micrometastasis in clinical staging and predicting prognosis of the pancreatic head carcinoma. Methods Pancreaticoduodenectomy with extended lymph nodes dissection were performed in 20 patients with pancreatic head carcinoma. All the lymph nodes were taken out by operating microscope method and metastasis was diagnosed by routine histological examination with hematoxylin and eosin staining, and the presence of lymph node micrometastasis was examined by immunohistochemisty. Results A total of 677 lymph nodes were found in the 20 cases, routine histological examination revealed metastasis occurred in 87 lymph nodes in 13 cases. Of the 590 negative lymph nodes by routine histological examination, 57 lymph nodes in 3 cases were diagnosed as having micrometastasis by immunohistochemisty. With the combination of routine histological examination and immunohistocbemisty, the percent of patients with positive lymph nodes increased from 65% （13/20） to 80% （16/20）, the detection rate of metastasis lymph node increased from 12.9% （87/677） to 21.3% （144/677） with significant difference （ P 〈 0.05）. The detection of lymph node micrometastasis changed the staging of ⅡA to ⅡB in 3 patients. Tumor metastasis and recurrence rate of patients with lymph nodes micrometastasis within one year after operation was 75%, while it was 25% of patients without lymph nodes micrometastasis. Conclusions The detection of lymph node mierometastasis metastasis was helpful in the determination of clinical staging and predication of prognosis.

关 键 词：胰腺肿瘤 淋巴转移 细胞角化蛋白 微转移 

分 类 号：R735.9[医药卫生—肿瘤]