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【摘要】目的探讨提高结直肠癌区域淋巴结阳性检出率的方法及其意义。方法分别采用淋巴结分离液查找区域淋巴结和应用逆转录聚合酶链反应(RT-PCR)扩增角蛋白19(K19)，对25例结直肠癌患者242个区域淋巴结进行重新分析和检测。结果13例结直肠癌患者区域淋巴结经淋巴结分离液处理，查找淋巴结数量由124个增至147个；12例结直肠癌患者84个病理检查未发现转移的淋巴结中经RT-PCR检测有8个存在微转移。结论利用淋巴结分离液可检出更多的结直肠癌区域淋巴结；RT-PCR方法是发现淋巴结微转移灶的一种敏感方法。两者结合可准确对结直肠癌患者进行分期，判断预后，指导治疗。
Clinical study on regional lymph nodes of colorectal carcinoma
LIU Lianjie, MENG Ronggui, XU Qizuo, et al.
Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
【 Abstract】 Objective To explore the metastases in regional lymph nodes of colorectal carcinoma and its clinical significance. Methods Fat clearance method was used to detect regional lymph nodes in colorectal cancer and reverse transcriptase-polymerase chain reaction (RT-PCR) to detect the expression of keratin 19(K19) mRNA in regional lymph nodes of 25 cases with colorectal carcinoma. 242 lymph nodes in all were reanalyzed. Results The detecting numbers of lymph nodes increased from 124 by routine method to 147 by fat clearance method in 13 cases of colorectal cancer. Among 84 negative lymph nodes in 12 cases of colorectal carcinoma, 8 lymph nodes were positive for expression of K19 mRNA by RT-PCR which meant micrometastases. Conclusions More regional lymph nodes can be found by fat clearance method and the K19 mRNA RT-PCR method can detect micrometastases of regional lymph nodes sensitively. These two methods are useful to provide accurate stage for colorectal carcinoma patients and information for prognosis and adjuvant therapy.
【 Key words】 Colorectal neoplasm; Lymph node; Polymerase chain reaction; Neoplasm metastasis
结直肠癌是常见的恶性肿瘤之一，根治术后复发、转移率高达50％左右。转移、微转移是结直肠癌根治术后不能根治的主要原因[1,2]。准确了解有无转移、微转移对临床诊断、治疗、预后判断具有重大意义。本文采用淋巴结分离液查找淋巴结和应用逆转录聚合酶链反应(RT-PCR)方法检测了25例结直肠癌区域淋巴结，发现前者可协助寻找更多的淋巴结，后者是诊断淋巴结微转移的一种敏感方法。
材料与方法
一、一般资料
选择结直肠癌根治术切除的肿瘤标本25例。术前均经纤维结肠镜及病理活检证实为腺癌。男14例，女11例。年龄26～78岁。高分化腺癌9例，中分化腺癌13例，黏液腺癌3例。13例为已经过常规病理检查后的标本，通过淋巴结分离液[3]进行处理并再次检取淋巴结，检出的淋巴结进行病理检查。12例肿瘤标本为新鲜标本，肿瘤切除后立即取区域淋巴结及部分肿瘤组织，PBS液清洗后淋巴结取一半液氮储存，另一半编号送常规病理。