本文選題：纖支鏡 + 前哨淋巴結(jié)　； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景： 對肺癌患者而言，如果排除遠處器官轉(zhuǎn)移，淋巴結(jié)轉(zhuǎn)移是預(yù)后不良的一個強有力的指標。為了明確患者淋巴結(jié)轉(zhuǎn)移情況及準確進行肺癌TNM分期，非小細胞肺癌患者行系統(tǒng)淋巴結(jié)清掃是必不可少的。 然而，系統(tǒng)淋巴結(jié)清掃會增加縱隔器官的損傷機會，延長麻醉及手術(shù)時間，增加手術(shù)創(chuàng)面。如何既能避免不必要的系統(tǒng)淋巴結(jié)清掃，又能切除有癌細胞轉(zhuǎn)移的淋巴結(jié)一直是備受臨床關(guān)注的問題。前哨淋巴結(jié)（sentinel lymph node SLN）概念的提出給我們帶來了解決這個問題的突破口。 SLN的識別和切除可以讓外科醫(yī)生在切除病灶前獲得惡性腫瘤的初步分期，這樣即能避免無淋巴結(jié)轉(zhuǎn)移患者的系統(tǒng)淋巴結(jié)清掃，又能保證有淋巴結(jié)轉(zhuǎn)移患者的遠期生存率。在黑色素瘤和乳腺癌患者中，SLN活檢已成為一個標準程序。在其他腫瘤，如宮頸癌，外陰癌，前列腺癌等，SLN動態(tài)檢測方法正凸顯在外科手術(shù)中的重要作用。 非小細胞肺癌前哨淋巴結(jié)的早期研究已經(jīng)取得了一定成功。在之前的研究中可以看到，锝-99硫膠體、锝-99錫膠體、锝-99納米膠體均可以作為SLN示蹤劑使用。然而，圍繞中心型非小細胞肺癌和內(nèi)窺鏡注射方法的研究卻很少。 目的： 本實驗以中心型非小細胞肺癌為研究對象，利用纖支鏡注射放射性同位素99mTc-硫膠體（technetium99m sulfur colloid99mTc-Sc），然后在開胸后探測各淋巴結(jié)區(qū)域的放射性計數(shù)，，找出SLN，再通過病理檢查及免疫組化判斷該方法作為淋巴系統(tǒng)轉(zhuǎn)移的準確性及敏感性。 方法： 1.20例術(shù)前已確定的可手術(shù)切除的非小細胞肺癌患者。 2.在手術(shù)麻醉前經(jīng)纖支鏡注射18.5~55.5MBq99mTc-硫膠體。 3.開胸后用伽馬探測儀掃描原發(fā)腫瘤，肺門淋巴結(jié)及縱隔淋巴結(jié)的放射性數(shù)值。 4.常規(guī)行肺切除術(shù)及系統(tǒng)淋巴結(jié)清掃術(shù)。 5.切除后的腫瘤及淋巴結(jié)于體外分別再進行放射性探測，記錄放射性數(shù)值。 6.行常規(guī)病理檢查及疫免組化檢測淋巴結(jié)內(nèi)的轉(zhuǎn)移灶。 結(jié)果： 1.17例患者檢測到了SLN，檢出率85%（17/20）。 2.檢測到SLN的患者中12例被測到僅有一枚SLN，3例有兩枚SLN，2例發(fā)現(xiàn)三枚SLN。 3.該方法作為判斷整個區(qū)域淋巴轉(zhuǎn)移的的敏感性是52%（9/17)，特異性是100%（3/3）。 結(jié)論： 纖支鏡注射同位素可以用于SLN示蹤，能夠更接近于患者生理狀態(tài)地顯示出SLN。該方法判斷淋巴系統(tǒng)轉(zhuǎn)移的特異性高。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R734.2

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相關(guān)期刊論文 前2條

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2 侯維平;曲家騏;王坤宇;陳憲英;張兆忠;高昕;滕洪;王述民;童向東;許世廣;劉博;楊雪鷹;程巖;;非小細胞肺癌術(shù)中~(99m)Tc標記前哨淋巴結(jié)的臨床研究[J];中國腫瘤臨床與康復(fù);2007年03期

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