前哨淋巴结定位检测在直肠癌外科中的应用研究

Clinical significance of sentinal lymph node mapping in rectal cancer surgery

目的探讨定位直肠癌前哨淋巴结(SLN)方法以及临床应用价值。方法运用体内或体外注射亚甲蓝定位47例SLN,采用术中冰冻切片检查、HE染色病理检查、CK-20免疫组化染色(S-P法)检查检测SLN中转移癌。结果体内定位SLN成功32例,体外定位15例,成功14例。47例患者总淋巴结数目为849枚,平均为18.86枚/例,总SLN定位成功率为97.87%,平均SLN为1.87枚/例。常规病理检测SLN转移阴性26例,其中免疫组织化学方法检测CK-20发现微转移6例,上调23.08%(6/26)淋巴结转移阴性患者的病理分期。结论直肠癌体内、体外SLN定位均可获得成功;SLNCK-20免疫组化染色(S-P法)检查有助于提高早期直肠癌的病理分期准确率;SLN术中冰冻切片检查有助于术中指导切除范围。

Objective To investigate the feasibility of mapping sentinal lymph node （SLN） in vivo and in vitro and clinical significance of sentinel lymph node in rectal cancer. Methods Forty-seven patients treated by surgery for rectum were admitted to this hospital. A subserosal peritumoral injection of methylene blue was given before or after rectal resection. SLNs were harvested and examined by frozen sectioning, HE staining, immunohistochemical staining to identify micrometastasis. Results A total number of 849 lymph nodes were obtained （ 18.86 per patient）. In 97. 87% （46/47） of the patients , SLNs were identified with a mean of 1.87. SLN was the only site of metastasis in 8 patients with immunohistoehemical staining, but in 2 patients with HE staining. Six patients were upstaged from stage Ⅰ , Ⅱ toⅢ（ AJCC ,2002）. The upstaging rate from stageⅠ, Ⅱto Ⅲ （AJCC,2002） was 23.08% （6/26）. Conclusions SLN mapping of rectal cancer can be performed successfully not only in vivo but also ex vivo. Immunohistochemical staining may be helpful for upstaging of rectal cancer.