纳米碳标记前哨淋巴结活检在结直肠癌根治术中的应用研究

Research of Nanometre Carbon Labelling Sentinel Lymph Node for Biopsy Used in Radical Procedure of Colorectal Carcinoma

为探讨结直肠癌根治术中纳米碳标记前哨淋巴结活检的可行性和有效性，选取原发性结直肠癌患者40例，随机分为观察组和对照组，各20例。观察组于结直肠癌根治术中于癌肿肠段癌灶周缘约1cm正常组织处选取3～4个注射点，每注射点浆膜下注入纳米碳混悬注射液0．1～0．3ml，3～5min后沿黑染淋巴管走向寻找第1枚或第1组黑染淋巴结，并用缝线标记为前哨淋巴结，术后对前哨淋巴结行细胞角蛋白20（CK20）免疫组化测定。对照组于结直肠癌根治术中未行纳米碳示踪剂注射，离体肿瘤肠段标本30min内进行解剖寻找前哨淋巴结并行CK20免疫组化测定。结果显示，观察组共采集纳米碳标记的前哨淋巴结58枚，平均2．9枚／例，其中淋巴结大小（直径）〈0．5cm、0．5～1．0cm、〉1．0cm分别占标记前哨淋巴结的53．4％、32．8％和13．8％；淋巴结转移率为63．8％，TNM重新分期率为60．0％，标记前哨淋巴结对淋巴结转移预测敏感度为82．4％。对照组共收集前哨淋巴结67枚，平均3．4枚／例，其中淋巴结大小（直径）〈0．5cm、0．5～1．0cm、〉1．0cm分别占总前哨淋巴结的16．4％、74．6％和9．0％；淋巴结转移率为38．8％，TNM重新分期率为25．0％，前哨淋巴结对淋巴结转移预测敏感度为47．1％。两组淋巴结转移率、TNM重新分期率、淋巴结转移预测敏感度方面比较差异均有统计学意义，P〈0．05或P〈0．001。结果表明，结直肠癌根治术中采用纳米碳示踪剂标记前哨淋巴结，可精准、全面地收集前哨淋巴结，提高淋巴结转移的检出率和TNM分期的准确性。

In order to explore the feasibility and effectiviness of nanometre carbon（NC） labelling sentinel lymph node （SLN） for biopsy in radical procedure of colorectal carcinoma,in this study 40 patients with primary colorectal carcinoma were randomly divided into observation group and control group, n =20 for each group;in the former during radical procedure select 3,4 injection points from normal tissue about 1 cm far from around range of cancer lesion at intestinal segment,inject NC suspension injection of 0.1-0.3 ml at subserosus of every injection-points,3-5 min later along with blackened lymphovessel seek the first lymph node or the first group of lymph node blackened and label them by suture thread,i.e sentinel lymph nodes, then after operation, detect their cytokeratin 20 （CK20） by using immunohistochemical method; meanwhile,in control group didn＇t conducted NC tracer agent injection,only dissect isolated neoplasm intestinal segment specimen within 30 min after operation to seck SLN and detect its CK20 immunohistochemically. As results,in observation group the sampled NC lablled SLN were 58 totally,averaged 2.9/cases;in these lymph nodes that the size in diameter was 〈0.5 cm,0.5-1.0 cm and 〉1.0 cm accounted 53.4% ,32.8% and 13.8% of the labelled SLNs respectively;metastatic lymph node ratio（rN） was 63.8%,the ratio of TNM restaging was 60.0%,labelling SLN had 82.4% of prospective sensitivity to metastatic lymph node;while in control group above-data items were 67,3.4/cases; 16.4%, 74.6% and 9.0 ; 38.8%, 25.0%, 47.1% .Between both groups in rN,restaging ratio,prospective sensitivity there were statistical difference（ P 〈0.05 or P 〈0.01）.Results show that during colorectal carcinoma radical procedure NC labelling SLN can exactly and fully collect SLN,so that enhance the detection rate of metastatic lymph node and the accurate TNM stage.