改良亚甲蓝注射法增加直肠癌淋巴结检获的研究

Modefied Method of Methylene Blue Injection into the Superior Rectal Artery Improves Lymph Node Harvest in Rectal Cancer Specimens

目的:探讨采用改良的体外经直肠上动脉注射亚甲蓝法增加直肠癌标本淋巴结检获数的可行性。方法:选取2009年8月至12月中山大学附属第三医院胃肠外科收治的20例直肠癌患者的手术标本作为自身对照,先后采用传统触摸法和改良亚甲蓝注射法在同一标本上检获淋巴结,结果用配对t检验和交叉分类资料的卡方检验进行统计学分析。结果:20例手术标本经传统触摸法检获淋巴结共194枚,平均(9.7±0.7)枚/例。标本进一步循亚甲蓝染色多检获201枚淋巴结,其中57.2%为直径≤5 mm的小淋巴结。经过两次处理后20例直肠癌标本共检获淋巴结395枚,(19.8±0.9)枚/例,P<0.0001。用传统触摸法共发现有4例标本有淋巴结转移,经亚甲蓝注射法多发现4例阳性标本,经过两次处理后共有8例标本有淋巴结转移,转移率为40%,P=0.045 5。结论:改良的体外经直肠上动脉注射亚甲蓝法是一种简单、安全、经济的方法,不但能提高术后直肠癌标本淋巴结的检获数目,而且能发现更多的阳性淋巴结,提供更准确的分期,值得在临床推广。

Objective： To explore the feasibility of improving lymph node harvest in rectal cancer specimens by modified method of methylene blue injection into the superior rectal artery. Methods： Between August 2009 and December 2009, 20 rectal cancer patients treated in the Third Affiliated Hospital of Sun Yat-sen University were managed by traditional method of palpation and modified method of methylene blue injection into the superior rectal artery. The lymph nodes were picked up in three regions according to Dukes staging. Data of lymph node harvest were analyzed by paired t test and Х^2 test. Results： The total number of detected lymph nodes in traditional method group was 194. Another 201 lymph nodes were added to final harvest with modified method of methylene blue. The average lymph nodes detected by traditional method and modified method were 9.7 ± 0.7 and 19.8 ±0.9, respectively. In the modified method group, 57.2 % lymph nodes were smaller than 5mm. The number of patients with positive lymph nodes was 4 and 8 in traditional method group and modified method group, respectively, with significant differences （ P = 0.0455 ）. Conclusion： Modified method of methylene blue injection into the superior rectal artery is simple, safe and cheap. This method is helpful for improvement of lymph node harvest and accurate pathological staging.