结直肠癌前哨淋巴结体外标记的研究

目的探讨结直肠癌前哨淋巴结（SEN）体外亚甲蓝定位活检方法的可行性，研究前哨淋巴结组织学状况能否用于预测区域淋巴结转移情况。方法将32例手术切除的结直肠癌标本纵行剪开，在癌肿四周注射亚甲蓝，2—5min后沿着蓝染的淋巴管追踪寻找首先蓝染的前哨淋巴结。将其切下后单独进行病理切片，检测有无癌转移，并与系膜淋巴结病理结果予以比较。结果有30例标本成功显示57枚SLN，平均每例标本显示1．9枚SLN。在SLN阳性的13例患者中。5例非SLN呈阳性，8例非SLN呈阴性；在17例SLN为阴性的标本中，15例非SLN呈阴性，仅2例非SLN呈阳性。统计本组患者SLN标记成功率为93．8％（30／32），准确率为93．3％（28／30），假阴性率为11．8％（2／17），特异性为100％（13／13）。结论结直肠癌标本前哨淋巴结体外亚甲蓝标记法可行，其组织学状况可较准确反映区域淋巴结群的癌转移情况。

Ex vitro sentinel lymph node mapping in colorectal carcinoma

OBJECTIVE: To investigate the feasibility of ex vitro sentinel lymph node (SLN) mapping with methylene blue staining and its clinical value of predicting regional lymph node metastasis in colorectal cancer. METHODS: Methylene blue (1 ml) was injected submucosally around the tumor immediately after resection. After 2-5 minutes, the first blue-dyed lymph nodes, sentinel lymph nodes (SLNs), were harvested for pathological examination, and compared with the pathological results of other lymph nodes. RESULTS: Of the total 32 patients, 57 SLNs were successfully identified in 30 patients with an average of 1.9 nodes per person. The successful labeling rate was 93.8% (30/32). Among the 13 patients with positive SLNs, there were 5 patients with positive non-SLNs and 8 patients with negative Non-SLNs. Among the 17 patients with negative SLNs, there were 15 patients with negative non-SLNs and 2 patients with positive Non-SLNs. The accuracy of SLNs for regional lymph node metastasis was 93.3% (28/30), the false negative rate was 11.8% (2/17), and the specificity was 100% (13/13). CONCLUSIONS: Ex vitro sentinel lymph node mapping with methylene blue staining in colorectal carcinoma is technically feasible and can effectively reflect the metastatic situation of regional lymph nodes.