【作者】 张建良； 丁印鲁； 付勤烨； 胡三元；

【机构】 山东大学第二医院普通外科； 山东大学齐鲁医院普通外科；

【摘要】 目的:应用术中99mTC-SC示踪定位技术检查直肠癌(Sentinel lymph node,SLN), 并对其进行HE染色,探讨直肠癌SLN概念应用的可行性及指导手术切除范围中的价值。方法:行根治性手术的48例直肠癌病人,术前1小时于肿瘤旁黏膜下分3～4点注射1ml 99mTC-SC(1mCi,74MBq),术中“热点”的探测采用Neo2000前哨淋巴结跟踪仪进行检测。记录淋巴结的位置并予以摘除。每个前哨淋巴结切为两半,一半行HE染色,分析SLN在预测区域淋巴结转移状态中的价值,另一半液氮保存待行RT-PCR检测。结果:共检出淋巴结 884枚,每例病人8～21枚,平均18．42枚;48例病人均成功定位出前哨淋巴结,定位成功率100％。共检出前哨淋巴结108枚,占淋巴结总数的12．22％(108／884);每例病人前哨淋巴结数1～3枚,平均1．67枚。前哨淋巴结放射性活度在360～1500cpm,平均580 cpm。43 例前哨淋巴结位于肠旁;2例位于髂外动脉周围,3例位于髂内动脉周围。前哨淋巴结预测区域淋巴结转移状态的敏感性、特异性、准确性、假阴性率分别为73．33％、69．23％、79．17％、 26．67％。结论:应用99mTC-SC对直肠癌SLN进行定位活检安全、可行;能够发现直肠癌的异位淋巴引流,对手术切除范围有一定的指导意义;SLN病理状态可以代表区域淋巴结的转移状态。更多还原

【Abstract】 Objective: To investigate the feasibility and reliability of SLNB in rectal cancer by radioactive isotope using 99mTC-SC introperatively. Methods: 48 cases of rectal cancer confirmed by postoperative pathological diagnosis were enrolled. 1ml 99mTC-SC (1mCi, 74MBq) was injected endoscopically into the submucosal space adjacent to the tumor 1 hour before operation. Detection of " hot site" was conducted by Neo2000 sentinel lymph node navigator introperatively. SLN was labeled and resected to be pathologically examined in company with other lymph nodes postoperatively. After the tumor were resected completely, the resected specimen was detected for SLN by Neo2000 sentinel lymph node navigator. Each SLN was cut into two segments equally, one half for hematoxylin and eosin-stained detection, the other half for RT-PCR. the value of SLNB in prediction stutas of regional lymph nodes was evaluated. Results: 884 nodes ( average 18.42 per patient; range 8 to 12) were indentified in total. A total of 108 SLNs( average 1.67 per patient; range 1 to 3) were indentified. All of the 48 cases mapped SLN successfully, occupying 12.22% of the nodes. The successful rate was 100%. The radioactivity of SLNs was between 360-1500cpm detected by Neo2000 SLN navigator with an average 580 cpm. SLNs of 43 cases were pararectal nodes, 2 located at para-external iliac arteries, 3 located at para internal iliac artery. All of the latter 5 cases were low rectal cancer who underwent expanded lateral lymphadenectomy. Sensitivity, specificity, accuracy and false negative rate of SLNB in predicting stutas of regional lymph nodes was 73.33%, 69.23%, 79.17%, 26.67% respectively. Conclusion: SLNB in patients with rectal cancer was practical by Radioactive isotope using 99mTC-SC introperatively; SLNB could help to find abnormal lymphtic drainge, help to make sure of operative range. Pathological status of SLNs could reflect the metastatic status of regional lymph nodes.更多还原