结肠癌术中前哨淋巴结定位的临床意义

目的　探讨术中前哨淋巴结定位在结肠癌手术中的临床意义。方法　对 65例结肠癌患者术中注射亚甲蓝于紧邻肿瘤周围的正常肠壁浆膜下或粘膜下。蓝染的淋巴管术中可肉眼辨认出 ,并可循此寻找已被标记的前哨淋巴结。采用标准方式行结肠癌根治术。所有切除的淋巴结经HE染色 ,每个前哨淋巴结的多张切片经cytokeratin抗体免疫组化染色。 结果　65例患者中有 63例发现SLN ,检出率 96 9%。 93 8% ( 61/65 )的患者的前哨淋巴结能准确地预测其引流区域淋巴结受累情况 ;假阴性 2例 ,假阴性率 7 4% ( 2 /2 7)。 6例患者的前哨淋巴结中包含的微转移灶或单个癌细胞转移被常规HE染色遗漏 ,但是经CK免疫组化染色检出。 7例患者由于发现异常淋巴引流途径而导致肠系膜切除的范围的改变。结论　对结肠癌病例 ,前哨淋巴结定位技术能较准确地预测其引流区域淋巴结受累情况和发现异常淋巴引流途径 ,有助于决定切除范围 ;并且通过指导病理医生有选择性地对前哨淋巴结进行细致的病理检查以提高分期的准确性

CLINICAL SIGNIFICANCE OF SENTINAL LYMPH NODES INTRAOPERATIVELY MAPPING ON COLON CANCER

Objective: To investigate the effects of sentinel lymph nodes intraoperative mapping in the patients with primary colon cancer. Methods: 65 cases with primary colon carcinoma underwent subserosal or submucosal injection of Methylene blue during operation. Blue-stained lymphatics were visualized and followed to the SLN, which was tagged. The colectomy was completed in standard fashion. All lymph nodes were stained by hematoxylin and eosin, and multiple sections of the negative SLNs by routine pathological examination were also examined by cytokeratin antibody immunohistochemical(IHC) stainging. Results: Sentinel lymph nodes of 63 cases were successfully stained and identified with methylene blue. The successful rate was 96.9%. The SLN accurately predicted the tumor status of the nodal basin in 93.8% cases. False negative results were reached in 2 cases, False negative rate was 7.4%. Occult or clusters of tumor cells in SLN (micrometastasis) of 6 cases were missed in routine H&E sections but identified by IHC. In 7 cases, an unexpected lymphatic drainage pattern altered the extent of mesenteric resection. Conclusion: For patients with colon carcinoma, SLN mapping can accurately predict the tumor status of the nodal basin and identify unexpected lymphatic drainage pattern during colon resection. It may be helpful to alter the margins of resection. Furthermore, it may also improve the accuracy of staging by allowing a focused pathological examination of the SLN.