前哨淋巴结活检在乳腺癌手术中的应用.docVIP

前哨淋巴结活检在乳腺癌手术中的应用 　　【摘要】 目的：研究前哨淋巴结活检（SLNB）在乳腺癌手术中的应用。方法：回顾性分析本院2011年6月-2014年6月间收治的28例行乳腺癌手术患者的临床资料，于术前2～4 h在肿瘤下方或瘤床内注射0.4 mL/37MBq放射性物质99mTc_DX，术中用r探测仪定位并切除前哨淋巴结（SLN），再行乳腺肿瘤切除及腋窝淋巴结（ALN）清扫。首先对SLN及ALN进行常规HE检测，再行免疫组织化学（1HC）检测及逆转录多聚酶链反应（RT-PCR）检测细胞角蛋白19（CKl9）mRNA的表达以检测淋巴结的微转移。结果：本次研究的检出率为100%，共检出43枚前哨淋巴结。18例患者有1枚，5例2枚、5例3枚。腋窝淋巴结共检出67枚。患者经HE染色检测后发现4例发生转移；利用印片细胞学对患者前哨淋巴结的阴阳性进行判断，经检查后发现阳性5例，阴性23例。结论：乳腺癌SLNB是可行的，SLN可以预测ALN的转移情况，它在保乳方面起到了重要作用，并且有利于判断是否为患者行腋窝淋巴结清扫，值得推广使用。 　　【关键词】 前哨淋巴结活检； 乳腺癌； 腋窝淋巴结 　　【Abstract】 Objective：To study the application of sentinel lymph node biopsy in breast cancer operation.Method：The clinical data of 28 cases of breast cancer patients in our hospital from June 2011 to June 2014 were retrospectively analyzed， in the preoperative 2-4 h in tumor or tumor bed below the injection of 0.4 mL/37MBq radioactive substances 99mTc_DX， R detector was used tolocate and remove the sentinel lymph node， then breast tumor excision andaxillary lymph node cleaning. The first routine HE testing on SLN and ALN， andimmunohistochemistry （1HC） test and reverse transcription polymerase chain reaction（RT-PCR）detection of cytokeratin 19 （CKl9） mRNA expression in thedetection of lymph node micrometastasis.Result：The detection rate was 100%， a total of 43 pieces of sentinel lymph node detection. 18 patients had 1，5 cases of 2， 5 cases of 3. 67 axillary lymph nodes were detected. After HE staining detection found that 4 patients with metastatic.Using printing slice cytology of sentinel lymph node in patients with masculine， through inspection and found positive in 5 cases， 23 cases of negative.Conclusion： Breast cancer SLNB is feasible， the transfer of SLNS could predict ALN detected， it played an important role in protect milk， and is conducive to determine whether patients with axillary lymph node cleaning， use to be promoted. 　　【Key words】 Sentinel lymph node biopsy； Breast cancer； Axillary lymph node 　　乳腺癌是临床上比较常见的疾病，这种疾病发病机制比较复杂，诱因也比较多，且近年来发病率呈现上升趋势。随着科技的不断发展，乳