【摘要】 探讨125I标记的抗胃癌单克隆抗体McAb 3H11在胃癌放射免疫导向手术(RIGS)中的应用价值。方法：McAb 3H11以Iodogen法标记125I(放射性比活度37kBq/μg蛋白)，胃镜直视下注射于15例胃癌患者癌周粘膜下，给药剂量7.4～18.5MBq/0.2～0.5mg蛋白；给药后4～11天手术，术中使用手持式γ探测仪对肿瘤、胃周淋巴结、手术切缘等靶部位(T)进行放射性检测，以正常大网膜或远离肿瘤边缘8cm以上的正常胃壁为对照本底(NT)，T/NT≥3.5为判别胃癌及浸润胃壁的标准，T/NT≥3.0为判定转移淋巴结的标准；探测结果与术后病理检验结果对照；对探测阳性而术后常规病理检验阴性的淋巴结重新连续切片，进行免疫组织化学染色。结果：RIGS判别切缘癌浸润的总特异性和准确率分别为96.5%和93.3%；注射125I-McAb 3H11后6～8天手术的患者RIGS结果较为满意(n＝7例)，判别区域淋巴结转移的敏感度、特异性及准确率分别为80.8%、96.8%和89.5%，免疫组化染色证实RIGS检出部分病例中常规病理检验未发现的淋巴结微小转移癌；实施RIGS对患者及术者均无明显不良影响。结论：应用125I标记抗胃癌单克隆抗体McAb 3H11进行胃癌放射免疫导向手术，可有效判别区域淋巴结转移，有助于指导胃癌根治性手术的实施。更多还原

【Abstract】 To evaluate the clinical usefulness of 125I-labeled monoclonal antibody(McAb)3H11 in radioimmunoguided surgery(RIGS) for patients with gastric cancer. Methods: Fifteen patients with gastric cancer were administered radiolabeled McAb 3H11 submucosally via endoscope, and all underwent surgical exploration 4 to 11 days later. Intraoperative radioimmunodetection was performed using a portable gamma-detecting probe. The counts in the target sites were obtained, and tumor-to-normal tissue(T/NT) ratio was calculated. The T/NT ratio of 3.5:1 was taken as the lowest threshold value of positivity for gastric wall infiltration, and 3.0:1 for lymph node metastasis. For RIGS-positive lymph nodes which were negative by routine histology, serial sections were subsequently made; immunohistochemical staining was performed to detect the lymphatic micrometastasis. Results: The accuracy rate in detecting tumor infiltration of the incisional margins was 93.3%, and the specificity 96.5%. In the patients in whom the opera- tion was carried out 6 to 8 days after the injection(n=7), the RIGS results were satisfying. For the detection of lymphatic metastasis, the sensitivity of RIGS was 80.8%, the specificity 96.8%, and the accuracy 89.5%. Immunohistochemistry verified the existence of lymphatic micrometastasis in 40%(2/5) of the RIGS-positive but histology-negative lymph nodes. Conclusions: This study validates the use of 125I-labeled monoclonal antibody 3H11 for intraoperative detection of carcinomatous lesions.更多还原