结直肠癌前哨淋巴结体外亚甲蓝染色的临床研究

Clinical evaluation of sentinel lymph nodes by in vitro Methylene blue staining in colorectal cancer

目的探讨用体外亚甲蓝作为染色剂寻找前哨淋巴结(sentinel lymph node,SLN)的方法在结直肠癌SLN定位中的临床价值。方法将根治性切除大肠癌标本,在肿块四周浆膜下注射亚甲蓝后常规固定送病理检查。蓝染的淋巴结视为SLN。结果67例患者中找到SLN的有63例(91.3%),SLN镜下转移14例(22.22%)。结肠的SLN转移阳性的诊断价值与非SLN相比差异有统计学意义(P=0.0005),但在直肠癌中SLN转移阳性的诊断价值与非SLN相比差异无统计学意义(P=0.60),且SLN转移阳性在结肠癌病例中假阴性率为11.11%,而在直肠癌病例中则高达42.86%。结论体外亚甲蓝染色寻找SLN的方法在结肠癌中的应用是有效、可靠的,但在直肠癌中的应用其可靠性值得进一步的研究。

Objective To study the clinical significance of sentinel lymph node （SLN） detection by in vitro Methylene blue staining in colorectal cancer. Methods The radically resected specimens of oolorectal cancer was injected with Methylene blue into into subserosa of the large bowel around the tuner. The specimens were fixed routinely and subjected to subsequent pathologic examination. The blue stained lymph nodes were considered as SLNs. Results SLNs were detected in 63 of 67 patients with a successful detection rate of 91.3 %. The metastatic SLNs were found in 14 patients （22.22%）. In oolon cancer,the incidence of metastasis was significantly higher in SLNs than in non- SLNs（ P = 0.0005）. However in rectal cancer,there was no significant difference in the inddenoe of metastasis between SLNs and non- SLNs. The false negative rate of SLN metastasis in colon cancer was 11.11% ,while in rectal cancer 42.86 %. Conclusion In vitro Methylene blue staining is an accurate diagnostic procedure for detecting SLNs in patients with oolon cancer. But its application in detecting SLNs in rectal cancer needs further study.