^(99)Tc^m-DX直肠淋巴引流显像研究

Study of lymphatic drainage imaging of rectum with ^(99)Tc^m-DX

目的 探讨99Tcm 右旋糖酐 (DX)直肠淋巴引流显像术前诊断直肠癌淋巴结转移的临床价值。方法 直肠癌患者 17例 ,正常对照者 2 0例。肛镜引导下 ,分左右两侧直肠粘膜下注射99Tcm DX ,每点 37MBq(0 .5mL)。注射后不同时间行γ照相。结果 ①对照组直肠淋巴引流图 :向头侧引流的淋巴链完整、对称 ,近似“八”字形、梯形。肠旁、肠外淋巴结向上引流至腹主动脉周围淋巴结 ;部分可以显示两侧髂内淋巴结 ;显影淋巴结数为 7～ 16个。②直肠癌组术前直肠淋巴引流异常 :向头侧引流的淋巴链不完整或不显影 ;淋巴结显影不清、缺损或增大 ,淋巴链呈“串珠”样。③直肠癌组术后行病理检查的 2 0 7个淋巴结中 ,31个为癌结节或癌转移。据Dukes分期法 ,直肠癌患者术前淋巴显像与术后病理检查结果对照 ,灵敏度为 91.6 % ,准确性 88.2 % ,特异性 80 .0 % ,假阳性率 2 0 0 % ,假阴性率 8.3%。结论 99Tcm DX直肠淋巴引流显像对直肠癌淋巴结转移的术前诊断有临床价值。

Objective To investigate lymphatic spread of rectal cancer on preoperative diagnosis with 99 Tc m-dextran (DX) imaging of lymphatic drainage of rectum. Methods In 17 patients with rectal cancer and 20 control subjects, 99 Tc m-DX was injected bilaterally into submucosa of the rectum through rectal endoscopy. Different intervals after injection, rectal lymphoscintigraphy was performed. Results ① Craniward lymphatic drainage of rectum was complete in control subjects, upward epirectal and pararectal lymph nodes were shown,only a part of internal 作者单位:310003 杭州,浙江大学医学院附属第一医院核医学科(沈文华?李林法?闻世凤?赵葵?程维荷?朱阳军),肛肠外科(黄学锋) iliac nodes were also visible. The number of the nodes was 7～16. ②Lymphatic drainage of rectum was incomplete in patients, defects or enlargement of the nodes were showed. ③In these cases histologic examination of the resected specimen demonstrated metastases in 31 of the 207 regional nodes.The stage was defined according to Dukes' standard, compared with histological node examination in all patients operated upon for rectal cancer, rectal lymphoscintigraphy showed the sensitivity of 91.6%, accuracy of 88.2%, specificity of 80.0%, false positivity of 20.0%, and false negativity of 8.3%. Conclusion The method is valuable for evaluating lymphatic metastases of rectal cancer before operation.