结肠癌前哨淋巴结的术中定位检测及其意义

目的探讨结肠癌前哨淋巴结(sentinellymph node,SLN)术中定位的可行性及其临床意义.方法对56例结肠癌患者(男35例,女21例,年龄34～86岁)应用术中染料定位的方法对其SLN进行了定位,绿染的第1个淋巴结为SLN,术后从根治性切除的标本中寻找SLN及区域淋巴结.常规HE染色检查找到的所有淋巴结;对常规检查为阴性的SLN进行抗CEA免疫组化染色(SP法),寻找阳性染色的淋巴结.结果共检出SLN 130枚,占全部区域淋巴结的13%(130/999).每例患者的SLN为1～4枚,平均2.5枚.HE染色共发现有SLN转移者15例,24枚,患者SLN转移率为27%(15/56);SLN阳性率为18%(24/130).除SLN外的869枚淋巴结的转移率为6%(52/869).肿瘤细胞在SLN的转移率明显高于在区域淋巴结内的转移率(P＜0.01).免疫组化法检测SLN微转移的发生率为75.5%(80/106),明显高于常规HE染色检出的转移率(P＜0.05).结论通过对结肠癌SLN进行术中定位,术后深入细致的病理学检测,可以在不增加病理科医生工作量的情况下明显提高对结肠癌淋巴结转移的检出率.

Sentinel lymph node mapping during operation and significance in colon carcinoma

Objective To investigate a convenient and accurate method to detect the sentinel lymph node (SLN) and its clinical significance in colon carcinoma. Methods SLNs of 56 cases with colon carcinoma were mapped by staining method. The SLNs were searched in the sample after radical excision, which were green, and then examined of metastasis of lymph nodes by routine hematoxylin and eosin (HE) staining. When the lymph nodes were negative by HE stain, the immunohistochemical staining was used to detect the micrometastasis of SLN. Results A total of 130 SLNs among all 999 regional lymph nodes were inspected in the 56 cases, 1 to 4 SLNs in each patient, average 2.5. Metastasis was diagnosed in 15 cases and totally 24 SLNs by HE staining. The metastasis rate of SLN was 27% (15/56) in cases and 18%(24/130) in SLNs. Metastasis rate was 6% (52/869) in the 869 regional lymph nodes except for the 130 SLNs. The metastasis rate was higher in SLNs than in regional lymph nodes. Micrometastasis rate was 75.5% (80/106) in SLNs. The metastasis rate was higher by immunohistochemical stain than by HE staining (P<0.05). Conclusion The SLN mapping of patients with colon carcinoma during operation and afterwards pathologic examination is a good method to diagnose the metastasis rate of lymph node.