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[目的]探讨前哨淋巴结(SLN)微转移检测在提高直肠癌病理分期及预测区域淋巴结转移中的价值。[方法]2003年12月至2005年12月行根治性手术的48例直肠癌患者采用同位素标记的方法进行SLN定位检查,SLN行常规病理检查,并进一步应用免疫组织化学(IHC)和逆转录聚合酶链式反应(PCR)方法进行微转移的检测。[结果]48例患者共检出SLN108枚,占淋巴结总数的12.22%(108/884)。经HE/IHC/PCR检查,48例患者中,SLN转移者共38例,无转移者10例,SLN预测区域淋巴结转移状态的准确率为79.17%(38/48)。常规病理前仅SLN阳性2例,检测微转移后仅SLN阳性12例,10例患者病理分期由Dukes’B期上升到C期。[结论]应用CK-20蛋白或其mRNA表达检测同位素示踪法所检出的直肠癌SLN微转移情况,具有较高的预测直肠癌区域淋巴结转移状态的价值,并有助于提高直肠癌病理分期的准确性。
[Objective] To investigate the value of sentinel lymph node (SLN) micrometastasis detection in improving the pathological staging of rectal cancer and predicting regional lymph node metastasis. [Methods] Forty-eight patients with rectal cancer who underwent radical surgery from December 2003 to December 2005 were examined by SLN using isotope-labeled method. SLN was performed routine pathological examination and immunohistochemistry (IHC) and reverse transcription Polymerase chain reaction (PCR) method for the detection of micrometastases. [Results] A total of 108 SLNs were detected in 48 patients, accounting for 12.22% (108/884) of the total lymph nodes. According to HE / IHC / PCR, 38 out of 48 patients had SLN metastasis and 10 had no metastasis. The accuracy of SLN in predicting regional lymph node metastasis was 79.17% (38/48). Only 2 cases of SLN were positive before routine pathology. Only 12 cases of positive SLN were detected after micrometastasis. The pathological staging of 10 patients increased from Dukes’B phase to C phase. [Conclusion] The micrometastasis of SLN in rectal cancer detected by isotope tracer method using CK-20 protein or its mRNA expression detection has a higher value of predicting lymph node metastasis status in rectal cancer and helps to improve the pathology of rectal cancer Staging accuracy.