术中前哨淋巴结定位及CK-20检测淋巴结微转移在结肠癌患者中的临床意义  

Clinical significance of sentinel lymph nodes intraoperatively mapping and CK-20 detecting lymph node micrometastases on colon cancer

作　　者：王斌[1] 于侠[2] 

机构地区：[1]吉林省肿瘤医院腹部外科,吉林长春130012 [2]吉林大学第一医院

出　　处：《中国实验诊断学》2009年第4期498-500,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨提高结肠癌患者区域淋巴结阳性检出率的方法及其临床意义。方法对48例行根治性手术的结肠癌患者前哨淋巴结(SLN)进行了术中染料法定位检测,使结肠癌系膜前哨淋巴结染色并统计淋巴结数目,同时行抗细胞角蛋白20(CK20)免疫组化检查,检测其微转移情况。结果48例患者中有46例发现SLN,检出率95.8%。93.8%(45/48)的患者的前哨淋巴结能准确地预测其引流区域淋巴结受累情况;假阴性1例,假阴性率5.0%(1/20)。6例患者的前哨淋巴结中包含的微转移灶或单个癌细胞转移被常规HE染色遗漏,但是经CK20免疫组化染色检出。5例患者由于发现异常淋巴引流途径而导致肠系膜切除的范围的改变。结论对结肠癌病例,前哨淋巴结定位技术能较准确地预测其引流区域淋巴结受累情况和发现异常淋巴引流途径,有助于决定切除范围;对常规病理检查阴性的淋巴结行CK20免疫组化染色检测其微转移情况,可提高淋巴结阳性检出率,两者结合可准确的对结肠癌患者进行分期、判断预后、指导治疗。Objective To explore the methods to improving the metastases regional lymph of colon cancer and its clinical significance.Methods 48 cases with primary colon carcinoma injected Methylene blue to map the SLN during completed operation.The numbers of lymph nodes detected by colon cancer SLN screening. Immunohistochemistry with CK20 was used to detect lymph node micrometastasis. Results Sentinel lymph nodes of 48 cases were successfully stained and identified with Methylene blue. The successful rate was 95.8%. There were 18 cases positive and 28 cases negative in 46 cases which were stained by HE. Occult or clusters of cancer cells inSLN（ micrometastases）of 6 cases were missed in routine HE stain but identified by IHC（CK20） .In 5 cases, an unexpected lymphatic drainage pattern altered the extent of mesentefie resection. Conclusion For patients with colon carcinoma, SLN mapping can accurately predict the tumor status of the nodal basin and identify unexpectedlymphatic drainage pattern during colon resection. It may be helpful to alter the margins of resection; Immunohistocbemistry with CK20 to detect micrometastasis can increase the positive rate of negative lymph nodes by routine HE. These two methods are useful to provide accurate stage for colon carcinoma patients and information for prognosis and adjuvant therapy.

关 键 词：结肠癌 前哨淋巴结 CK20 微转移 

分 类 号：R735.35[医药卫生—肿瘤]