结直肠癌淋巴结微转移的临床研究

目的 探讨结直肠前哨淋巴结(SLN)的定位方法及检测淋巴结微转移的有效方法,并分析其临床意义.方法 对60例结直肠癌患者采用亚甲蓝染色法淋巴结示踪,寻找染色的SLN,切除后的SLN行HE染色和细胞角蛋白CK20免疫组化检测;并与前期直接行淋巴结清扫的60例患者对比.结果 亚甲蓝组中可识别SLN者54例(90.0%),高于前期直接清扫组的24例(40.0%)(P＜0.05);54例中行常规HE染色检出36例阳性,18例阴性.18例SLN阴性者行免疫组化检测,6例(33.3%)检出有微转移灶.结论 联合应用亚甲蓝和细胞角蛋白CK20进行结直肠癌SLN定位优于单用其中之一种方法;免疫组化是检测淋巴结微转移的敏感方法.

Clinical study on lymph node micrometastasis of colorectal cancer

Objective: To study the mothods in detecting  sentinel lymph node (SLN) and lymph node micrometastasis in patients with colorectal cancer and their clinical significance.
Methods: Sixty patients with colorectal cancer undergoing lymphatic mapping using methylene blue staining (group I) was analysed. The SLN was identified and removed, and the micro-metastases in sentinel lymph node were detected with HE and immunohistochemical staining technique. Other  sixty patients previously treated by direct radical lymphadenectomy were taken as comtrol group(gronp II).
Results: Fifty-four SLN were successfully identifed in group I,with a detection rate of 90.0%, which was higher than that of control group (24/60,40%)(P<0.05); in group I,  thirty-six positive SLN were dectected by HE staining, and six micro-metastases (33.3%) were found in eighteen negative SLN by use of Cytokeratin 20 immuno-histochemical staining.
Conclusions: The success rate achieved by combining methylene blue staining and cytokeratin 20 immunohistochemical staining in detecting SLN and lymph node microstasis is higher than that achieved by using either technique mentioned above alone.