大肠癌前哨淋巴结定位切除及其微转移检测_临床医学论文.docVIP

大肠癌前哨淋巴结定位切除及其微转移检测_临床医学论文 大肠癌前哨淋巴结定位切除及其微转移检测_临床医学论文 作者：张敏, 谭最， 菅志远， 江斌， 兰明银， 曾少波， 李恒， 王耕 [摘要] 目的：探讨大肠癌前哨淋巴结定位切除及检测淋巴结微转移的方法，并分析其临床意义。方法：对60例大肠癌患者采用亚甲蓝染法淋巴结示踪，寻找染色的前哨淋巴结,切除后行HE染色和细胞角蛋白20免疫组织化学检测,并与前期直接行淋巴结清扫的60例患者对比。 结果：60例中可识别前哨淋巴结者54例,检出率为90.0%，高于前期直接清扫组的24例（40%）（0.05）;其中常规HE染色检出36例阳性，18例前哨淋巴结阴性者应用免疫组织化学检测，6例检出有微转移灶,其阳性率大大高于对照组（0.05）。结论：联合应用亚甲蓝和细胞角蛋白20进行大肠癌前哨淋巴结定位优于单用其中一种方法；免疫组化方法是检测淋巴结微转移的敏感方法；前哨淋巴结定位和微转移的检测对大肠癌的治疗有重要意义。 　　[关键词] 大肠癌；淋巴结示踪；前哨淋巴结；微转移 　　Abstract: Objectives To identify the sentinel lymph nodes(SLN)in patients with colorectal cancer and evaluate their clinical significance.Methods Sixty patients with colorectal cancer underwent lymphatic mapping using methylene blue staining,the SLN was identified and removed,the micro-metastases in sentinel lymph node were also detected with HE and immunohistochemical staining technique.Results Fifty-four SLN were successfully identifed in sixty patients,with a detection rate 90.0%,higher than that of control group;thirty-six positive SLN were dectected by HE staining,six micro-metastases in Sentinel lymph node were found in eighteen negative SLN with Cytokeratin 20 immuno-histochemical staining. Conclusion The success rate achieved by combining methylene blue staining and cytokeratin 20 immunohistochemical staining is higher than that by using either technique alone；immunohistochemical assay is a sensitive way to detect micrometastases in lymph nodes,and this may have clinical significance for the treatment of colorectal cancer. 　　Key words: Colorectal cancer; Lymph nodes trace； Sentinel lymph node; Micrometastasis 　　周围淋巴结的转移情况直接关系到肿瘤的病理分期、预后判断和术后辅助治疗方案的选择。传统的大肠癌前哨淋巴结 (Sentinel lymph node，SLN) 活检可能会将已有转移的淋巴结遗漏在切除的标本或体内，而无法检出淋巴结微转移灶(1ymph node micrometastasis，LNMM)[1]；细胞角蛋白(Cytokeratinl 20,ＣＫ20)作为细胞骨架广泛分布于胃肠上皮组织及其来源的肿瘤组织胞浆中,在大肠癌中高度表达[2]。如何联合应用这两种方法对前哨淋巴结进行准确定位，并了解阴性淋巴结的微转移情况，本文应用亚甲蓝在术中对大肠癌进行前哨淋巴结的示踪和定位，并结合ＣＫ20免疫组化法（Immunothistochemical,IHC)对其进行淋巴结微转移LNMM检测，以探讨SLN在大肠癌的临床意义。 　　1 资料和方法 　　1.1 临床资料2004年10月－2006年6月在我院住院