经皮经肝淋巴超声造影检测兔VX2肝癌前哨淋巴结的实验研究  

Experimental study in detecting sentinel lymph nodes by percutaneous transhepatic lymphosonography in VX2 hepatic cancer rabbit

作　　者：董磊[1] 王双龙[1] 张彦[1] 李迪[1] 刘晓红[1] 

机构地区：[1]济南军区总医院超声科,济南250031

出　　处：《中华超声影像学杂志》2013年第2期158-161,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨经皮经肝淋巴超声造影探测兔VX2肝癌前哨淋巴结的可行性及应用前景。方法建立兔VX2肝癌模型25只，经皮经肝在肿瘤边缘12点、3点、6点、9点同时注射0．05mlSonoVue，造影模式下观察肿瘤周围及肝门区显影的淋巴管及淋巴结，借助门静脉、胰头、胆囊颈部标记探测到淋巴结的位置。再经皮经肝在相同部位注射亚甲蓝（MB），按摩5min后处死实验兔，行淋巴结清扫，分别统计显影淋巴结、蓝染淋巴结的数量并送病理检查。结果25只荷瘤兔经手术病理诊断前哨淋巴结（SLN）34枚；经皮经肝淋巴超声造影检测出28枚淋巴结手术证实均为SLN；而MB示踪法检测出31枚淋巴结中25枚为SLN，6枚为下一级淋巴结。以手术探查为标准，经皮淋巴超声造影探测SLN的检出率为82．4％（28／34），MB示踪法探测SLN的检出率73．5％（25／34），两种方法的检出率比较差异无统计学意义（P=0．169）。以病理结果为标准，经皮经肝淋巴超声造影检测到的SLN中均匀性增强6枚（癌转移2枚），非均匀性增强22枚（癌转移21枚），判断sI。N转移的敏感性为95．5％（21／28），特异性为66．7％（4／6），准确性为89．3％（25／28）。结论经皮经肝淋巴超声造影是检测肝癌SLN以及判断SLN是否转移的一种可靠、无创的方法。Objective To investigate the feasibility and promising applications of percutaneous transhepatic lymphosonography in detecting sentinel lymph nodes （SLNs）. Methods Twenty-five rabbits with VX2 tumor were included in this study. 0.05 ml SonoVue was injected into the liver parenchyma at 12, 3,6,9 points around the VX2 tumor. The situation of contrast-enhanced lymph-vessel emited from injected point and lymph nodes in hepatic portal or around tumor was observed,and then the position of the lymph nodes were detected with the help of the mark on the surface of the portal vein, caput pancreatis, collum vesicae biliaris. Methylene blue （MB） was injected in the same way as above. The injected points were massaged for five minutes, and then executed the experimental rabbits. The lymph nodes enhanced and all the lymph node dyed or not were taked out for recorded and pathologic examination. Results 34 SLNs were conformed by operation and pathological diagnosis in all the rabbits. All SLNs were confirmed pathologically,28 lymph nodes which were checked out by percutaneous transhepatic lymphosonography were all SLNs. In all the 31 lymph nodes which were checked out by MB,25 lymph nodes were SLNs and the rest were the second degree lymph nodes. The detection rate of percutaneous transhepatic lymphosonography （82.4O/oo） and the MB （91.20/00） showed no significant difference（ P = 0. 169）. There were 6 SLNs enhanced uniformitily in which 2 SLNs encroach by cancer cell and 22 enhanced asymmetrically in which 21 SLNs encroach by cancer cell. The sensitivity, specificity and accuracy of percutaneous transhepatic lymphosonography to detcect the SLNs benign or malignancy was 95.5% （21/28） ,66. 7% （4/6） and 89.3% （25/28）. Conclusions Percutaneous transhepatic lymphosonography is a reliable and noninvasive method to detect and estimate the SLNs of hepatic cancer.

关 键 词：超声检查 微气泡 肝肿瘤 前哨淋巴结 

分 类 号：R735.7[医药卫生—肿瘤]