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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0.5～1.0mL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。
Objective To investigate the value of lymphatic mapping (LM) and sentinel lymph node (SLN) localization in laparoscopic colon cancer surgery. Methods 32 patients with colon cancer were treated with fiberoptic colonoscopy with 0.5-1.0mL of isosulfan dye injected into the submucosa around the tumor. The blue stained SLN was clearly observed by laparoscopy. Colon surgery using standard resection. All lymph nodes were stained with hematoxylin and eosin (HE), and each SLN was taken from multiple sites. HE staining and anti-cytokeratin immunohistochemistry (IHC) staining were performed simultaneously. Results All patients identified at least one SLN under laparoscopy. 94% detected SLN successfully and correctly reflected the tumor status of lymph nodes in this area. Eight cases (25.0%) of the blue-stained lymphatic vessels were outside the preoperative range and had a wide mesorectal excision. Four cases (12.5%) of patients with SLN by HE staining negative IHC staining confirmed the existence of micrometastases. Conclusion SLN mapping in laparoscopic resection of colon cancer can guide the removal of the range; combined application of IHC staining can improve tumor staging, the patient’s surgical approach to selection and prognosis of more accurate assessment.