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目的探讨结肠癌术中定位前哨淋巴结(SLN)的可行性并研究其在结肠癌外科诊疗中的临床意义。方法对73例结肠癌患者进行术中异硫蓝定位检测SLN,术后常规病理检测所有淋巴结,对常规病理检测阴性者进行细胞角蛋白(CK,AE1/AE3)免疫组化检测。结果73例患者中检出SLN 72例共157枚,平均每例2.2枚。常规病理检出53例共116枚SLN发生转移。SLN预测区域淋巴结转移状况的敏感性为93.0%,准确性为94.5%。免疫组化检测可以发现微转移,降低淋巴结转移检测的假阴性率。结论结肠癌术中进行SLN定位是可行的,可以发现肿瘤异常淋巴引流,SLN基本可代表区域淋巴结状况,提高术后病理学分期的准确性,但以SLN活检术替代传统术式的可行性和安全性尚需要实施多中心、大样本、前瞻性随机对照研究。
Objective To investigate the feasibility of positioning sentinel lymph node (SLN) in colon cancer and to study its clinical significance in surgical treatment of colon cancer. Methods Seventy-five patients with colon cancer underwent intraoperative isosulfan blue staining for detecting SLN. All the lymph nodes were routinely examined by pathology. Cytokeratin (CK, AE1 / AE3) immunohistochemistry was performed on patients with negative histopathology. Results A total of 72 cases of SLN were detected in 73 cases, with an average of 2.2 cases per case. A total of 116 cases of SLN metastasis were detected in 53 cases by routine pathology. The sensitivity of SLN to predict regional lymph node metastasis was 93.0% and the accuracy was 94.5%. Immunohistochemical detection can detect micrometastases and reduce the false negative rate of lymph node metastasis. CONCLUSIONS: It is feasible to locate SLN during colon cancer operation. Abnormal lymphatic drainage can be found in the colon cancer. SLN can basically represent the regional lymph node status and improve the accuracy of postoperative pathological staging. However, the feasibility of using SLN biopsy instead of traditional operation and Security also requires the implementation of multicentre, large, prospective randomized controlled studies.