前哨淋巴结检验对腹腔镜下结直肠癌根治及临床分期的应用价值  

Value of lymphatic mapping and sentinel node analysis in laparoscopic resection and staging of colorectal cancer

作　　者：耿辉[1] 汤黎明[2] 费福林[1] 秦锡虎[1] 黄海[1] 贾华[1] 须新涛[1] 黄建峰[1] 

机构地区：[1]常州市中医医院普通外科,213003 [2]常州市第二人民医院胃肠外科

出　　处：《江苏医药》2011年第13期1565-1567,共3页Jiangsu Medical Journal

摘　　要：目的探讨腹腔镜下定位结直肠癌前哨淋巴结(SLN)方法,以及对手术和病理分期的价值。方法选择26例腹腔镜下结直肠癌根治术患者行腹腔镜下淋巴结标记,采用HE染色检测,CK免疫组化染色检查SLN中转移癌。结果 26例腹腔镜下前哨淋巴结标记均顺利。4例(16.7%)提示淋巴结引流超出最初计划切除的边缘,需要扩大切除范围。24例(92.3%)前哨淋巴结反映腹腔淋巴结肿瘤情况;其中,8例(33.3%)发现淋巴结转移,4例(16.7%)常规病理检查为阴性,经免疫组化检查证实为阳性。结论腹腔镜下结直肠癌前哨淋巴结标记可提高结直肠癌病理分期的准确性。Objective To discuss the method of lymphatic mapping and sentinel node analysis and its significance in laparoscopic resection and staging of colorectal cancer.Methods The lymphatic mapping and sentinel lymph node（SLN） analysis were performed in 26 patients with colorectal cancer underwent laparoscopic colectomy.Subserosal or submucosal injection of isosulfan blue dye via a colonoscope was carried out with a percutaneously inserted spinal needle.All lymph nodes were stained by hematoxylin and eosin and multiple sections of each SLN were examined by immunohistochemistry（IHC） staining using cytokeratin antibody.Results Labeling SLN was successful in all patients.Four cases（33.3%） were found an unexpected lymphatic drainage pattern and the extent of mesenteric resection needed to be extented.The SLN accurately predicted the tumor status in 92.3%（24/26） cases,in whom an unexpected lymphatic metastasis was found in 8 cases（33.3%） and extented mesenteric resection was performed,and 4 cases（16.7%） had negative report pothologically,but positive by IHC.Conclusion The accuracy of tumor staging can be improved with SLN mapping in colorectal cancer.

关 键 词：腹腔镜 结直肠癌 前哨淋巴结 

分 类 号：R735[医药卫生—肿瘤]