【摘要】 目的　探讨放射性核素淋巴显像对中低位直肠癌侧方淋巴结转移的诊断价值。方法选择 1999年 5月至 2 0 0 1年 3月经病理证实的大肠癌患者 32例 ,以99m锝 硫胶体 (99mTc SC)为显像剂 ,于术前 1日行盆腔、下腹部放射性核素淋巴显像。 32例中直肠癌 2 7例 ,乙状结肠癌 3例 ,结肠癌2例。对 15例腹膜返折以下直肠癌行侧方淋巴结清扫的扩大根治术 ,将其显像结果与术后侧方淋巴结病理检查进行对照。结果　直肠旁淋巴结 ,闭孔淋巴结 ,髂血管、主动脉淋巴链的显像率分别为6 9 %、91%、10 0 %。行侧方淋巴结清扫的 15例直肠癌 ,其核素显像对称 10例 ,不对称 5例。侧方淋巴结病理阳性率 13% (2 /15 )。以图像不对称为显像阳性 ,结果表明核素显像的灵敏度为 10 0 % ,特异度为 77% ,符合率为 80 %。结论　盆腔、下腹部核素显像是术前判断中低位直肠癌侧方淋巴结是否转移的较好方法 ,此法有助于制定合理的个体化手术方案。更多还原

【Abstract】 ObjectiveTo assess the diagnostic value of preoperative lymphoscintigraphy for lateral lymph node metastasis in low rectal cancer. MethodsFrom May 1999 to March 2001, pelvic and lower abdominal lymphoscintigraphy with 99mTc sulfur colloid was performed on 32 patients with proven colorectal cancer one day prior to operation. Among these patients were 27 rectal cancers, 3 sigmoid cancers and 2 colon cancers. Fifteen cases of rectal cancer with the tumor located at or below the peritoneal reflection received extended lymphadenectomy with lateral dissection (D3 lymphadenectomy). The result of lymphoscintigrams was correlated with histologic lateral node examination. Results The image ratio of pararectal nodes, obturator nodes, and internal iliac aorti lymph trains was 69%, 91%, and 100% respectively. In 15 patients receiving D3 lymphadenectomy, 10 had negative lymphoscintigrams whereas 5 had positive image, and the lateral pathology positive rate was 13%(2/15). Analysis of these results revealed the sensitivity (100%), specificity (77%) and accuracy (80%) of this diagnostic method. ConclusionPelvic and lower abdominal lymphoscintigraphy with 99mTc sulfur colloid could demonstrate the lateral lymph node drainage of low rectal cancer, and the correlation with postoperative histologic lateral node examination was high enough to enable surgeons to adopt an individualized surgical approach.更多还原