脂肪清除技术在结肠癌病理分期中的应用

Application of fat clearance technique in pathologic staging for colon cancer

目的探讨用脂肪清除技术获取手术标本中的全部淋巴结是否对肿瘤的精确分期具有临床意义．方法2007年6月至2008年12月间有91例结肠癌根治术患者的手术标本入组研究．其中2007年6月至2008年1月间．采取常规方法即通过肉眼加触摸对标本获取淋巴结（常规方法组，45例）；2008年2—12月间，采取脂肪清除技术处理后对标本获取淋巴结（脂肪清除组，46例）。结果脂肪清除组平均每例患者淋巴结检出数目为32．7枚．明显多于常规方法组的15．3枚（P〈0．01）：两组平均阳性淋巴结数分别为2．7和1．8枚，差异亦有统计学意义（P〈0．05）。对于横结肠癌、左半结肠癌、L3-4期结肠癌以及小于或等于3cm的淋巴结，脂肪清除组阳性淋巴结数显著高于常规方法组（P〈0.05）；而对于右半结肠癌、T1-2期结肠癌以及大于3cm的淋巴结，两组阳性淋巴结数的差异无统计学意义（P〉0.05）。脂肪清除组术后Ⅲ期病例显著多于术前（31例比19例，P〈0．05）；而常规方法组手术前后Ⅲ期病例的差异无统计学意义（21例比19例，P〉0．05）。结论脂肪清除技术能显著增加淋巴结检出数和阳性淋巴结数，提高术后分期的准确性。

Objective To evaluate whether the use of fat clearance technique improves the accuracy of staging for colon cancer. Methods Between June 2007 and December 2008, surgical specimens of 91 patients with colon cancer were procured. Between June 2007 and January 2008, routine technique for lymph node harvest including visualization and tactile sensation was used in 45 patients （conventional group）, while lymph nodes of 46 patients between February 2008 and December 2008 were examined using fat clearance technique （fat clearance group）. Results The mean of lymph nodes harvested was 32.7 using fat clearance technique, significantly higher than that （15.3） of the conventional group （P〈0.01）. The mean positive lymph nodes was 2.7 and 1.8 in the two groups, respectively, with a statistically significant difference （P〈0.05）. There were more stage Ⅲ colon cancer in the postoperative staging than that in the preoperative staging using fat clearance technique （31 vs.19, P〈0.05）, while there was no difference in stage Ⅲ colon cancer between postoperative staging and preoperative staging using conventional method （21 vs.19, P〉0.05）. Conclusions Fat clearance technique significantly increases number of lymph node retrieval and positive nodes, therefore the accuracy of postoperative staging is improved.