大肠癌前哨淋巴结定位切除及其微转移检测

Lymphatic Mapping,Sentinel Node Biopsy and Micro-metastasis Detection in the Patients with Colorectal Cancer and their Clinical Significance

目的:探讨大肠癌前哨淋巴结定位切除及检测淋巴结微转移的方法,并分析其临床意义。方法:对60例大肠癌患者采用亚甲蓝染法淋巴结示踪,寻找染色的前哨淋巴结,切除后行HE染色和细胞角蛋白20免疫组织化学检测,并与前期直接行淋巴结清扫的60例患者对比。结果:60例中可识别前哨淋巴结者54例,检出率为90.0%,高于前期直接清扫组的24例(40%)(P<0.05);其中常规HE染色检出36例阳性,18例前哨淋巴结阴性者应用免疫组织化学检测,6例检出有微转移灶,其阳性率大大高于对照组(P<0.05)。结论:联合应用亚甲蓝和细胞角蛋白20进行大肠癌前哨淋巴结定位优于单用其中一种方法;免疫组化方法是检测淋巴结微转移的敏感方法;前哨淋巴结定位和微转移的检测对大肠癌的治疗有重要意义。

Objectives To identify the sentinel lymph nodes（SLN） in patients with colorectal cancer and evaluate their clinical significance. Methods Sixty patients with colorectal cancer underwent lymphatic mapping using methylene blue staining, the SLN was identified and removed,the micro- metastases in sentinel lymph node were also detected with HE and immunohistochemical staining technique. Results Fifty - four SLN were successfully identifed in sixty patients, with a detection rate 90.0% ,higher than that of control group;thirty -six positive SLN were deetected by HE staining,six micro- metastases in Sentinel lymph node were found in eighteen negative SLN with Cytokeratin 20 immuno - histochemical staining. Conclusion The success rate achieved by combining methylene blue staining and cytokeratin 20 immunohistochemical staining is higher than that by using either technique alone;immunohistochemical assay is a sensitive way to detect micrometastases in lymph nodes, and this may have clinical significance for the treatment of colorectal cancer.