术中肠系膜下动脉注射亚甲蓝溶液对T2期直肠癌淋巴结检出数目的影响

Change of T2 stage rectal cancer＇s lymph nodes by injecting methylene blue into the inferior mesentericartery of intraoperative

目的探讨直肠癌根治术中使用亚甲蓝溶液注入肠系膜下动脉对T2期的直肠癌标本淋巴结的检出情况。方法对2004年12月至2011年6月间43例T2期直肠癌患者术后标本进行研究分析，其中2004年12月至2008年8月间，采取常规方法即肉眼加触摸对标本获取淋巴结（常规方法组，23例）；2008年9月至2011年6月采取术中肠系膜下动脉注射亚甲蓝溶液配合常规方法获取淋巴结（亚甲蓝注射组，20例）。比较2组的淋巴结检出情况及阳性淋巴结检出情况。结果亚甲蓝注射组共检出淋巴结484枚，平均淋巴结检出数为（24±14）枚；常规方法组检出淋巴结总数为214枚，平均淋巴结检出数为（9±5）枚，2组差异有统计学意义（P〈0．05）。亚甲蓝注射组共检出直径〈5mm的淋巴结228枚，平均淋巴结检出数为（11．4±6．4）枚；常规方法共检出直径〈5mm淋巴结印枚，平均淋巴结检出数为（3．0±1．4）枚，2组差异有统计学意义（P〈0．01）。亚甲蓝注射组共检出22枚阳性淋巴结，平均检出数为（1．1±1．0）枚；常规方法组共检出16枚阳性淋巴结，平均检出数为（0．7±0．6）枚，2组差异无统计学意义（P〉0．05）。结论对于T2期直肠癌患者实施根治术时采用肠系膜下动脉注射亚甲蓝溶液可以明显提高淋巴结检出数目，从而可能提高术后分期的准确性，为术后的辅助治疗提供依据。

Objective To study whether injecting methylene blue into the inferior mesenteric artery（IMA） in the redical operation of T2 stage rectal cancer can harvest more lymph nodes than the conventional method. Methods From December 2004 to June 2011, 43 specimens of T2 stage colorectal cancer were studied, including 23 cases of conventional method group （using the naked eye and douching specimens to get lymph nodes ） in December 2004 to August 2008, and 20 cases of methylene blue injection group （ injecting methylene blue into the interior mesenteric artery combined with the conventional method） in September 2008 to June 2011. Results The average lymph nodes of each patient in the methylene blue injection group were（24 ± 14）pieces, significantly more than the conventional method group（ P 〈 0.01 ） ; and the lymph nodes of 〈 5 mm diameter was also significantly more than that in the conventional method group （P 〈0.01 ） ; but the average positive lymph nodes of two groups were （ 1.1 ± 1.0） pieces and （ 0.7 ± 0.6 ） pieces, and the difference was not statistically significant （ P 〉 0.05 ）. Conclusion In T2 stage rectal cancer, the method of injecting methylene blue into the inferior mesenteric artery can find out many lymph nodes, and may improve the accuracy of the postoperative staging, accordingly provides the basis for the postoperative adjuvant therapy.