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目的探讨~(99)锝~m-硫胶体(~(99)Tc~m sulfur colloid,~(99)Tc~m-sc)联合纳米炭注射法示踪结肠癌前哨淋巴结(sentinel lymph node,SLN)的临床应用价值。方法前瞻性收集2015年8月至2016年7月期间在青岛市中心医院行结肠镜病理学检查确诊为原发性结肠癌的40例患者,该40例患者行结肠全系膜切除术前,经结肠镜于肿瘤周围黏膜下注射2.0 mL ~(99)Tc~m-sc和纳米炭混悬注射液的混合液,并行单光子发射型计算机断层扫描/同机CT融合扫描(SPECT/CT)检查,术后所有切除的淋巴结行病理学检查。结果 40例结肠癌患者共检出淋巴结660枚,平均16.5枚/例。其中36例成功检出1~4枚SLN,共计88枚,平均2.4枚/例,SLN检出率为90.0%(36/40);余4例结肠癌SLN示踪失败。HE联合免疫组化染色结果显示,检出SLN的36例患者中,淋巴结转移26例(其中1例无SLN癌转移,而有非SLN癌转移,即假阴性),无淋巴结转移10例。本组40例结肠癌SLN的检出准确率为87.5%(35/40),灵敏度为96.2%(25/26),假阴性率为3.8%(1/26)。结论 ~(99)Tc~m-sc联合纳米炭注射法行结肠癌SLN示踪定位是可行的,是一种判断结肠癌区域淋巴结转移状况的准确而有效的手段。
Objective To investigate the effect of 99 99Tc-m-sulfur colloid (~ 99) Tc ~ m sulfur colloid and ~ (99) Tc ~ m-sc on the detection of sentinel lymph node (SLN) ) Clinical value. Methods Forty patients with primary colon cancer confirmed by colonoscopy at Qingdao Central Hospital from August 2015 to July 2016 were prospectively collected. The patients underwent total mesorectal excision, A single photon emission computed tomography / CT fusion scan (SPECT / CT) was performed by injecting a mixture of 2.0 mL ~ (99) Tc ~ m-sc and nano- Check, all resected lymph nodes after the pathological examination. Results A total of 660 lymph nodes were detected in 40 patients with colon cancer, with an average of 16.5 cases. Of the 36 cases, 1 ~ 4 SLNs were successfully detected, a total of 88, with an average of 2.4 pieces / case, the detection rate of SLN was 90.0% (36/40); the other 4 cases of colon cancer SLN failed. The results of HE immunohistochemical staining showed that among the 36 patients with SLN detected, there were 26 cases with lymph node metastasis (1 case had no SLN cancer metastasis, but non-SLN cancer metastasis, ie false negative), and 10 cases had no lymph node metastasis. The detection rate of SLN in 40 cases of colon cancer was 87.5% (35/40), the sensitivity was 96.2% (25/26) and the false negative rate was 3.8% (1/26). Conclusion The ~ (99) Tc ~ m-sc combined with nanocarbon injection is feasible and feasible for SLN tracing of colon cancer and is an accurate and effective method for judging the status of lymph node metastasis in colon cancer.