结直肠癌术中前哨淋巴结定位的研究

Research of Sentinel Lymph Node Mapping in Operation of Colorectal Cancer

目的探讨结直肠癌前哨淋巴结的检测及其对淋巴结转移的预测,用于指导手术范围。方法术中注射异硫蓝方法对43例结肠癌患者进行手术中前哨淋巴结的临床研究,手术中取前哨淋巴结作快速冰冻病理并与术后常规蜡块病理相对照,观察冰冻病理前哨淋巴结转移与常规病理肠系膜淋巴转移的相关性,及其对肠系膜淋巴结转移的预测价值。结果43例结直肠癌病人中,42例确定了前哨淋巴结,前哨淋巴结活检成功率97.7%。42例病人共检出淋巴结142个,检出前哨淋巴结35个。将前哨淋巴结冰冻病理与常规病理结果对照,42例结肠癌病人中15例患者证实淋巴结有转移,13例有前哨淋巴结转移,其中9例有非前哨淋巴结转移,4例无非前哨淋巴结转移;29例无前哨淋巴结转移,其中27例无非前哨淋巴结转移,2例有非前哨淋巴结转移。检出特异性为100%(27/27),敏感性为86.7%(13/15),前哨淋巴结假阴性率为13.3%(2/15)。结论检测前哨淋巴结对结肠癌淋巴结转移有重要价值,可以用于指导临床手术。

Objective: The purpose of this study is to discuss if sentinel lymph node(SLN) mapping technique could be used to identify SLNs in colorectal cancer and to forecast the metastases of sentinel lymph nodes.Methods: By injecting subserosally the Lymphazurin around the tumor without injecting into the lumen,the clinical research to sentinel lymph nodes in the surgical operation has been performed on 43 patients suffered from the colorectal cancer,where the fast-frozen pathology of sentinel lymph nodes is compared to the general wax pathology after the surgery to observe the relativity between sentinel lymph node metastases of fast-frozen pathology and the mesenteric lymph node metastases of general wax pathology,as well as its forecast value on the mesenteric lymph node metastases.Result: SLN was successfully identified in 42 of 43 patients,with a Biopsy rate of 97.7%.In 42 patients,there were 142 lymph nodes examined,of which 35 nodes were identified as SLNs.Compared the frozen pathology result of sentinel lymph node with that of general pathology,15 cases of 42 patients suffered from colorectal cancer are identified positive for the metastases of lymph nodes,and 13 patients are positive for metastases of sentinel lymph nodes;of which,9 cases of 13 patients are positive for the metastases of non-SLNs and the rest 4 cases are negative for the metastases of nonSLNs;there are 29 patients negative for non-SLNs metastases,of which,27 patients are negative for metastases of sentinel lymph nodes and the rest 2 cases are positive for the metastases of non-sentinel lymph nodes.The specificity is 100%(27/27),and sensitivity is 86.7%(13/15),false negative rate is 13.3%(2/15).Conclusions: The SLN mapping in colorectal cancer plays an important role in the metastases of the lymph nodes,and can be used to direct the clinical surgery.