结肠癌前哨淋巴结活检的临床研究

Clinical study of sentinel lymph node biopsy in colon cancer

目的:探讨结肠癌前哨淋巴结(sentinel lymph node,SLN)活检技术的可行性及其临床意义。方法:对26例结肠癌患者应用术中染料定位的方法对其S LN进行了定位,术后从根治性切除的标本中检出SLN及区域淋巴结。对所有淋巴结行常规HE染色,HE染色为阴性的淋巴结进行免疫组化检测,寻找阳性染色的淋巴结。结果:共检出SLN 65枚,占全部区域淋巴结的14%。HE染色共发现有SLN转移者9例,17枚,患者SLN转移率为35%;SLN阳性率为26%。除SLN外的403枚淋巴结的转移率为6%。肿瘤细胞在SLN的转移率明显高于在区域淋巴结内的转移率(P<0.01)。免疫组化法检测SLN转移的发生率为54%。结论:SLN活检能够预测结肠癌区域淋巴结转移状况,对SLN行深入细致的病理学检测,可以指导术后病理分期和制定综合治疗方案。

Objective：To investigate the feasibility of detecting the sentinel lymph node （SLN） and its clinical significance in colon cancer. Methods： SLNs of 26 cases with colon cancer were mapped by staining method. The SLNs and all regional lymph nodes were searched in the sample after radical excision, and then examined metastases of lymph nodes by routine hematoxylin and eosin （HE） staining. When the lymph nodes were negative by HE stain, the immunohistchemical staining was used to detect the mierometastases of SLNs and regional lymph nodes. Results： A total of 65 （14%） SLNs among all regional lymph nodes were inspected in the 26 cases. Metastases was diagnosed in 9 cases and totally 17 SLNs by HE stai ning. The metastases rate of SLN was 35% in cases and 26% in SLNs. Metastases rate was 6% in the regional lymph nodes except for the SLNs. The metastases rate was higher in SLNs than in regional lymph nodes （P 〈0.01）. Metastases rate was 54% in SLNs by immunohistehemical staining. Conclusion： The SLN mapping of patients with colon cancer can predict the metastases state of the regional lymph nodes and afterwards pathologic examination SLNs may improve the staging system for colon cancer and also assist treatment programs.