单光子发射型计算机断层扫描-同机CT融合技术联合纳米炭混悬液注射法在直肠癌前哨淋巴结示踪中的应用  

Application of ^99mTc-SPECT-CT and carbon nanoparticles suspension injection in sentinel lymph node mapping for rectal cancer

作　　者：王亚楠[1] 李贵平[2] 龚伟[3] 邓永健[4] 池晓华[2] 周新华[4] 余江[1] 张策[1] 胡彦锋[1] 程侠[1] 李国新[1] 

机构地区：[1]南方医科大学南方医院普通外科,广州510515 [2]南方医科大学南方医院核医学科,广州510515 [3]南方医科大学南方医院消化科,广州510515 [4]南方医科大学南方医院病理科,广州510515

出　　处：《中华胃肠外科杂志》2011年第5期352-355,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技计划项目基金（2006812901006）;广州市科技攻关项目基金（200623-E0571）

摘　　要：目的探讨单光子发射型计算机断层扫描-同机CT融合技术（SPECT—CT）联合纳米炭混悬液注射法对直肠癌前哨淋巴结（SLN）进行示踪的临床价值。方法2010年1-12月间共12例临床分期为cT1-2N0M0直肠癌患者纳入本研究，术前1d通过肠镜于直肠癌周围黏膜下注射1ml纳米炭混悬注射液与1ml^99m锝标记的硫胶体（^99m—Sc）混合而成的示踪剂，注射后1、3、5h分别行SPECT—CT扫描。明确SLN数量并分析SLN区域。术后将术前SPECT—CT显示的SLN区域中所有淋巴结进行放射性测量．取放射性计数值最高的1枚或几枚淋巴结确定为SLN（数量已由术前SPECT—cT确定）。所有的SLN区域淋巴结行CK免疫组织化学（免疫组化）检测。结果SLN示踪成功率为91．7％（11／12），SLN数目为1-3枚／例。SLNCK免疫组化检测阴性的10例患者其他区域淋巴结亦为阴性；1例SLNCK免疫组化检测阳性的患者其他区域淋巴结亦为阳性（4／20）：前哨淋巴结对区域淋巴结转移情况的预测准确率达100％。结论SPECT—CT联合纳米炭混悬注射液可有效明确早期直肠癌患者SLN的解剖位置及数目，准确预测区域淋巴结转移情况．值得进一步研究。Objective To evaluate the accuracy of sentinel lymph node mapping （SLM） in patients with rectal cancer by single-photon emission computed tomography （SPECT-CT） lymphoscintigraphy and carbon nanoparticles suspension injection. Methods Twelve patients with clinical T1-2N0M0 rectal cancer were selected and locally injected with teehnetium-^99msulfur-colloid and carbon nanoparticles suspension by endoscope one day before surgery, followed by SPECT-CT scanning 1, 3 and 5 hours later. Radioactive isotope（RI） uptake of each sentinel node（SN） basin with location preoperatively determined by SPECT-CT was postoperatively calculated using gamma probe. Nodes with the highest RI uptake, the number of which was also pre-determined by SPECT-CT, was defined as SNs. Immunohistochemical cytokeratin staining was performed for all the SNs and non-SNs. Results The rate of sentinel node detection was 91.7%（11/12） with at least one SN （1-3） per patient. Ten cases showed metastasisnegative in SNs as well as all the resected regional nodes by immunohistochemical cytokeratin staining. Only one patient had positive nodes in both SN and non-SNs. The accuracy of SLM was 100%. Conclusion SPECT-CT lympboscintigraphy and carbon nanoparticles suspension injection can effectively detect the anatomic location and number of sentinel nodes, and improve the accuracy of SLM for rectal cancer.

关 键 词：直肠肿瘤 单光子发射型计算机断层扫描-同机CT融合技术 纳米炭 前哨 淋巴结 

分 类 号：R735.37[医药卫生—肿瘤]