纤支镜注射同位素示踪剂在非小细胞肺癌前哨淋巴结的初步探讨

发布时间：2018-07-12 18:26

本文选题：纤支镜 + 前哨淋巴结　；参考：《重庆医科大学》2014年硕士论文

【摘要】：研究背景：对肺癌患者而言，如果排除远处器官转移，淋巴结转移是预后不良的一个强有力的指标。为了明确患者淋巴结转移情况及准确进行肺癌TNM分期，非小细胞肺癌患者行系统淋巴结清扫是必不可少的。然而，系统淋巴结清扫会增加纵隔器官的损伤机会，延长麻醉及手术时间，增加手术创面。如何既能避免不必要的系统淋巴结清扫，又能切除有癌细胞转移的淋巴结一直是备受临床关注的问题。前哨淋巴结（sentinel lymph node SLN）概念的提出给我们带来了解决这个问题的突破口。 SLN的识别和切除可以让外科医生在切除病灶前获得恶性肿瘤的初步分期，这样即能避免无淋巴结转移患者的系统淋巴结清扫，又能保证有淋巴结转移患者的远期生存率。在黑色素瘤和乳腺癌患者中，SLN活检已成为一个标准程序。在其他肿瘤，如宫颈癌，外阴癌，前列腺癌等，SLN动态检测方法正凸显在外科手术中的重要作用。非小细胞肺癌前哨淋巴结的早期研究已经取得了一定成功。在之前的研究中可以看到，锝-99硫胶体、锝-99锡胶体、锝-99纳米胶体均可以作为SLN示踪剂使用。然而，围绕中心型非小细胞肺癌和内窥镜注射方法的研究却很少。目的：本实验以中心型非小细胞肺癌为研究对象，利用纤支镜注射放射性同位素99mTc-硫胶体（technetium99m sulfur colloid99mTc-Sc），然后在开胸后探测各淋巴结区域的放射性计数，，找出SLN，再通过病理检查及免疫组化判断该方法作为淋巴系统转移的准确性及敏感性。方法： 1.20例术前已确定的可手术切除的非小细胞肺癌患者。 2.在手术麻醉前经纤支镜注射18.5~55.5MBq99mTc-硫胶体。 3.开胸后用伽马探测仪扫描原发肿瘤，肺门淋巴结及纵隔淋巴结的放射性数值。 4.常规行肺切除术及系统淋巴结清扫术。 5.切除后的肿瘤及淋巴结于体外分别再进行放射性探测，记录放射性数值。 6.行常规病理检查及疫免组化检测淋巴结内的转移灶。结果： 1.17例患者检测到了SLN，检出率85%（17/20）。 2.检测到SLN的患者中12例被测到仅有一枚SLN，3例有两枚SLN，2例发现三枚SLN。 3.该方法作为判断整个区域淋巴转移的的敏感性是52%（9/17)，特异性是100%（3/3）。结论：纤支镜注射同位素可以用于SLN示踪，能够更接近于患者生理状态地显示出SLN。该方法判断淋巴系统转移的特异性高。
[Abstract]:Background: lymph node metastasis is a powerful indicator of poor prognosis for lung cancer patients if distant organ metastasis is excluded. In order to determine the lymph node metastasis and TNM staging of lung cancer, systemic lymph node dissection is essential in patients with non small cell lung cancer (NSCLC). However, systemic lymph node dissection can increase the chance of mediastinal organ injury, prolong anesthesia and operation time, and increase surgical wound. How to avoid unnecessary systemic lymph node dissection and remove lymph nodes with metastasis of cancer cells has been a focus of clinical attention. The concept of sentinel lymph node (SLN) has brought us a breakthrough to solve this problem. The identification and resection of SLNs can enable surgeons to obtain the initial stages of malignant tumors before removing the lesions. This can avoid systemic lymph node dissection in patients without lymph node metastasis and guarantee long-term survival rate of patients with lymph node metastasis. SLN biopsy has become a standard procedure in patients with melanoma and breast cancer. Dynamic detection of SLN in other tumors, such as cervical cancer, vulvar carcinoma, prostate cancer, etc., is playing an important role in surgery. Early studies of sentinel lymph nodes in non-small cell lung cancer have been successful. In previous studies, we can see that technetium-99 sulfur colloid, technetium-99 tin colloid, technetium-99 nanometer colloid can be used as SLN tracer. However, little research has been done on central non-small cell lung cancer and endoscopic injection methods. Objective: to study the central non-small cell lung cancer (NSCLC), the radioisotope 99mTc-Sc (technetium99m sulfur colloid 99mTc-Sc) was injected with bronchoscope, and the radioactivity counts of each lymph node region were detected after thoracotomy. The accuracy and sensitivity of SLN for lymphatic metastasis were determined by pathological examination and immunohistochemistry. Methods: 1. Twenty patients with non-small cell lung cancer (NSCLC) who had been identified as resectable before operation. 2. Before anaesthesia, 18.5 mTctc- sulfur colloid was injected by fiberoptic bronchoscope with 55.5 MBq99mTc- sulfur colloid. Radioactivity values of primary tumors, hilar lymph nodes and mediastinal lymph nodes were scanned with gamma detector after thoracotomy. 4. Routine pneumonectomy and systemic lymph node dissection. 5. The tumor and lymph node after resection were detected separately in vitro, and the radioactivity values were recorded. 6. 6%. The metastasis in lymph nodes was detected by routine pathological examination and immunocytochemistry. Results: 1.SLN was detected in 17 patients, the detection rate was 85% (17 / 20). Of the 12 patients with SLN detected, only one SLNN was detected in 3 patients. Two SLNs were found in 2 patients and three SLN.3 were found in 2 patients. The sensitivity and specificity of this method were 52% (9 / 17) and 100% (3 / 3) respectively. Conclusion: bronchofiberscope injection isotope can be used as SLN tracer, and SLN can be displayed more closely to the physiological state of the patients. The specificity of this method in judging lymphatic metastasis is high.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R734.2

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