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目的评价纳米碳注射法示踪前哨淋巴结(SLN)对结肠癌淋巴结转移状况判断的价值及对手术的指导意义。方法将青岛市中心医院胃肠外科于2013年3月至2016年3月间收治的行根治性切除术的51例结肠癌患者作为实验组(开腹或腹腔镜手术),于术前在结肠镜下将纳米碳示踪剂1 ml(50 mg)分4~6个点注射于原发肿瘤周围正常黏膜下进行SLN标记显像,手术中分别记录染色SLN数目及未染色淋巴结数目,术后行病理学检查;选取同期行根治性切除手术中未进行纳米碳示踪剂标记的结肠癌患者60例作为对照组。结果实验组51例通过注射纳米碳共清扫淋巴结1 065枚,平均每例20.9枚,SLN检出率100%,其中获取纳米碳染色淋巴结412枚,平均每例8.1枚,黑染度为38.7%,发现有淋巴结转移者27例,共发现转移淋巴结192枚,平均每例7.1枚,其中纳米碳染色转移淋巴结63枚,黑染度为32.8%。平均每例获取淋巴结总数和转移淋巴结数目上两组差异有统计学意义(P均<0.05)。SLN示踪对结肠癌区域淋巴结转移状况预测的灵敏度为77.8%,准确率为88.2%,特异性100%,假阴性率为22.2%。结论 SLN基本可代表区域淋巴结转移状况,通过纳米碳示踪SLN检测,能明显提高结肠癌根治术的淋巴结清扫数量,提高肿瘤淋巴结转移的检出率,且可以发现肿瘤异常淋巴引流,同时提高术后病理学分期的准确性。对于指导手术切除范围以及指导术后治疗等方面具有重要意义。
Objective To evaluate the value of SLN traced by nano-carbon injection in the diagnosis of lymph node metastasis of colon cancer and its guiding significance for surgery. Methods Fifty-one patients with colon cancer undergoing radical resection from March 2013 to March 2016 in Department of Gastrointestinal Surgery, Central Hospital of Qingdao were enrolled as experimental group (laparotomy or laparoscopic surgery) Microscopically, 1 ml (50 mg) of nanocarbon tracer was injected into the normal submucosa around the primary tumor at 4 ~ 6 points for SLN imaging. The number of stained SLN and the number of unstained lymph nodes were recorded during the operation. 60 patients with colon cancer who were not labeled with carbon nanotubes during radical resection were selected as the control group. Results In the experimental group, 1 065 lymph nodes were cleared by injection of nano-carbon, with an average of 20.9 cases and an SLN detection rate of 100%. 412 of them were obtained, with an average of 8.1 per case and a black dye of 38.7% , Found that there are 27 cases of lymph node metastasis, a total of 192 metastatic lymph nodes were found, an average of 7.1 per case, of which 63 carbon nano-metastatic lymph nodes, black dyed 32.8%. The average number of lymph nodes and the number of metastatic lymph nodes in each case was statistically significant (P <0.05). The sensitivity of SLN tracing to predicting lymph node metastasis of colon cancer was 77.8%, the accuracy was 88.2%, the specificity was 100%, and the false negative rate was 22.2%. Conclusion SLN can basically represent the status of regional lymph node metastasis. The SLN detection by nano-carbon tracer can obviously improve the number of lymph node dissection and the detection rate of lymph node metastasis, and can find the abnormal lymphatic drainage of tumor, Post-pathological staging accuracy. It is of great significance for guiding the scope of surgical resection and guiding the postoperative treatment.