前哨淋巴结活检在结直肠癌根治术中的应用研究  

Clinical study of sentinel lymph node biopsy in radical surgery for colorectal cancer

作　　者：黄宝玉[1] 王伟[1] 朱建伟[1] 刘培根[1] 黄华[2] 马利林[1] 

机构地区：[1]南通大学附属医院普外科,226001 [2]南通大学附属医院病理科,226001

出　　处：《临床外科杂志》2011年第8期544-546,共3页Journal of Clinical Surgery

摘　　要：目的探讨前哨淋巴结活检（SLNB）在结直肠癌根治术中临床应用的可行性及其价值。方法应用美蓝对67例结直肠癌患者行前哨淋巴结（SLN）定位活检，分体内、体外组，采用HE染色病理检查法、CK-20免疫组化染色（SP法）检测SLN中转移癌。结果共检出淋巴结660枚，其中SLN130枚，检出率19．7％。腹腔镜结直肠癌根治术和开腹结直肠癌根治术对SLN的检出差异无统计学意义（P=0．742）；体内、体外两种SLN的标记方法差异无统计学意义（P=0．564）；SP法检测SLN癌转移的敏感性明显高于HE染色，而假阴性率明显低于后者；肿瘤细胞在SLN的转移率明显高于区域淋巴结的转移率（P〈0．01）。结论结直肠癌根治术中体内、体外SLN定位方法均可以获得成功，均具有切实的可行性，与手术方式无关，并能够预测区域淋巴结的转移状况；通过SP法检查有助于明确结直肠癌的病理分期，有利于判断预后和个体化治疗方案的制定。Objective To investigate the feasibility and applied value of sentinel lymph node biopsy （SLNB） in radical surgery for colorectal cancer. Methods Sentinel lymph nodes （SLNs） were mapped in vivo and in vitro in the 67 cases of colorectal cancer,with methylene blue injected into subserosa. SLNs were then harvested and examined by HE staining and immunohistochemical（IHC） staining to identify metastasis. Results A total of 130 （ 19.7% ） SLNs among all lymph nodes （660） were inspected. There was no significant difference between laparoscopic resection and radical surgery for colorectal cancer （P = 0. 0564） ,as well as between the method of SLNs mapped in vivo and in vitro（ P =0.564）. The sensitivity in immunohistochemical method was higher than in HE staining method used to identify metastasis of SLNs, and its false negative rate of SLN status in diagnosis of node metastasis was lower. The metastasis rate was higher in SLNs than in regional lymph nodes （P 〈 0.01 ）. Conclusions SLN mapping of radical surgery for colorectal cancer can be performed successfully not only in vivo but also in vitro, and predict the metastasis state of the regional lymph nodes verily, regardless of surgical mode. Immunohistochemical staining（ SP method）may be helpful for pathologic staging of colorectal cancer, judging the prognosis and developing individualized treatment programs.

关 键 词：前哨淋巴结 结直肠癌 淋巴结转移 

分 类 号：R735.37[医药卫生—肿瘤]