胃癌前哨淋巴结活检染色剂选择的实验研究

Experimental Study of the Choice of Vital Dyes for Sentinel Lymph Node Biopsy in Gastric Cancer

目的用亚甲蓝(methylene blue,MB),专利蓝(patent blue,PB)及两者混合为染色剂,进行动物实验研究,为临床挑选合适的染色剂提供依据。方法24只成年大耳家兔随机分为3组,观察3种不同的染色剂在胃浆膜下注射后到达前哨淋巴结(sentinel lymph node,SLN)及下一站淋巴结的时间,染色淋巴结枚数以及褪色时间。结果在兔的胃浆膜下分别注射了亚甲蓝,专利蓝及两者联合的染色剂后到达SLN的平均时间为7.56s,9.13s,8.69s,专利蓝与联合组之间没有统计学意义(P=0.435),亚甲蓝组时间则短于专利蓝(P=0.000)和两者联合组(P=0.009)。到达第2站淋巴结的时间分别为19.32s,31.56s,23.34s。第2站淋巴结染色时间上亚甲蓝组快于联合组(P=0.017),联合组快于专利蓝组(P=0.000)。各组在检出前哨淋巴结的数目上没有明显区别(P>0.05)。褪色时间专利蓝为13.06min,两者结合组为82.13min,亚甲蓝组在观察了120min后没有明显褪色。组间比较差异明显(P=0.000)。结论亚甲蓝和专利蓝各有其优缺点,实验中两种联用可以取得互补的作用,是一种较理想的示踪剂。

Objective To study the choice of vital dyes for sentinel lymph node biopsy （SLNB） in gastric cancer, we used patent blue（PB） , methylene blue（MB） and methylene blue plus patent blue （MB ＋ PB） as dyes and compared the efficiency in lymph nodes staining in experimental animals. Methods Twenty - four adult rabbits were randomly divided into three groups. Three kinds of dyes （PB, MB, and PB ＋ MB blend） were injected into the gastric sub -serosa of eight rabbits in each group respectively. The dying time of the sentinel and the second station of lymph nodes ,the number of the dying nodes and the fading time of the dying lymph nodes were observed after injection. Results The average time covered for sentinel lymph nodes being stained was 7.56s, 9.13s,8.69s in MB,PB and M B ＋ PB injection groups respectively. There was no obvious difference between PB and PB ＋ M B groups （P = 0. 435 ）. But the time in M B group was shorter than that in PB（ P = 0. 000） and PB ＋ MB（0. 009） groups. The average dying time of the second lymph nodes by MB, PB, MB ＋ PB was 19.32, 36.56, 23.34s respectively. The time in MB group was shorter than that in MB ＋ PB group（ P = 0. 017 ） , which was shorter than that in PB group（ P = 0. 000）. There were no differences among different groups in the number of the dying nodes （P 〉 0. 05）. The average fading time of the lymph nodes stained by PB and MB ＋ PB was 13.06 min and 82. 13min, we observed the lymph nodes stained by MB 120 min, they were still stained deeply. There were dramatically differences among three groups（ P = 0. 000）. Conclusion Application of MB and PB possess their advantage and disadvantage in sentinel node biopsy. The mixture of patent blue and methylene blue could overcome the shortage of the two vital dyes in the experimental study and be an ideal tracer for the use.