淋巴绘图和前哨淋巴结定位在腹腔镜结肠癌切除术中的应用
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王全晖

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Application of lymphatic mapping and sentinel node analysis in laparoscopic colectomy for colon carcinoma
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    摘要:

    目的:探讨淋巴绘图(LM)和前哨淋巴结(SLN)定位分析在腹腔镜结肠癌手术中的应用价值。
    方法:32例结肠癌患者,术中在纤维电子肠镜辅助下,将0.5~1.0 mL异硫蓝染剂注射在瘤体四周的黏膜下层,随即通过腹腔镜观察,蓝染的SLN清晰可见。结肠采用标准术式切除。所有淋巴结经苏木精-伊红(HE)染色,对每一个SLN进行多点取材,同时进行HE染色及抗细胞角蛋白免疫组织化学(IHC)染色双重病理检查。
    结果:所有患者在腹腔镜下至少识别1个SLN。94%成功检出SLN,并正确反映了该区域淋巴结的肿瘤状况。8例(25.0%)蓝染的淋巴管系超出了术前预计范围,术中实行了宽系膜切除。4例(12.5%)患者的SLN经HE染色阴性而IHC染色证实存在微转移灶。
    结论:SLN绘图在腹腔镜结肠癌切除术中,可以指导切除范围;联合应用IHC染色可以提高肿瘤分期,将对患者手术方式的选择和预后评估更加准确。

    Abstract:

    Objective: To explore the value of lymphatic mapping (LM) and sentinel lymph node(SLN) analysis in laparoscopic colectomy for colon carcinoma. 
    Methods: Thirty-two patients with clinically localized colonic neoplasms were subjected to submucosal injection of isosulfan blue dye (0.5-1.0 mL) via a colonoscope during operation. Blue-stained lymphatics were visualized through the laparoscope 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 each SLN were examined by immunohistochemical (IHC) staining using cytokeratin antibody. 
    Results: At least one SLN was identified laparoscopically in all patients. The SLN accurately predicted the tumor status of the nodal basin in 94% of cases. In 8 cases (25%), an unexpected lymphatic drainage pattern altered the extent of mesenteric resection. 〖JP2〗The SLN was negative by HE staining in 4 (13%) cases,  which were demonstrated positive for micrometastases through immunohistochemical staining.
    Conclusions: SLN mapping during laparoscopic colon resection can alter the margins of resection and in combination with immunohistochemical staining may improve staging, which may more accurately assign patients to prospective protocols.

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王全晖, 郭树军, 李永研, 吕金利.淋巴绘图和前哨淋巴结定位在腹腔镜结肠癌切除术中的应用[J].中国普通外科杂志,2009,18(10):1046-1048.
DOI:10.7659/j. issn.1005-6947.2009.10.012

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  • 收稿日期:2009-05-13
  • 最后修改日期:2009-06-16
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  • 在线发布日期: 2009-10-15