结肠癌术中定位前哨淋巴结的临床研究

Clinical study of sentinel lymph nodes intraoperatively mapping on colon cancer

目的探讨结肠癌术中定位前哨淋巴结(SLN)的可行性并研究其在结肠癌外科诊疗中的临床意义。方法对73例结肠癌患者进行术中异硫蓝定位检测SLN,术后常规病理检测所有淋巴结,对常规病理检测阴性者进行细胞角蛋白(CK,AE1/AE3)免疫组化检测。结果73例患者中检出SLN 72例共157枚,平均每例2.2枚。常规病理检出53例共116枚SLN发生转移。SLN预测区域淋巴结转移状况的敏感性为93.0%,准确性为94.5%。免疫组化检测可以发现微转移,降低淋巴结转移检测的假阴性率。结论结肠癌术中进行SLN定位是可行的,可以发现肿瘤异常淋巴引流,SLN基本可代表区域淋巴结状况,提高术后病理学分期的准确性,但以SLN活检术替代传统术式的可行性和安全性尚需要实施多中心、大样本、前瞻性随机对照研究。

Objective To study the feasibility of the sentinel lymph node（SLN） mapping during operation and clinical signif- icanc in diagnosis and treatment of colon cancer. Methods SLN was mapped during operation by staining method with isosulfan blue in 73 cases of colon cancer. All lymph nodes were checked by routine pathological technique, some of which were negative in routine HE staining were further analyzed with eytokratin AE1/AE3 （CK, AE1/AE3 ） via immunohistoehemistieal staining. Results One hundred and fifty - seven SLNs were identified in 72 patients, and the mean number was 2.2. 116 SLNs from 53 cases with lymph node metastasis were found by routine pathologic examnation. Sensitivity and accuracy of the SLN biopsy were 93.0% and 94.5% , respectively. Micrometastasis can be identified by immunohistochemistical staining, then the false - negative in metastasis identification can be reduced. Conclusions The SLN mapping during operation is feasible. The SLN can accurately predict the status of regional lymph nodes, SLN could indicate the range of abnormal lymph node drainage and improve accuracy rate of pathologic staging. But the feasibility and security for this technique to substitute the conventional surgical operation should be evaluated by prospective random comparison studies on muhicenter,large samples.