临床颈淋巴结转移阴性喉及喉咽癌前哨淋巴结检测  

The significance of sentinel lymph node biopsy in patients with NO laryngeal and hypopharyngeal squamous cell carcinoma

作　　者：李树春[1] 石胜利[1] 刘文中[1] 徐成钧[1] 方凤琴[1] 李振东[1] 李延国[1] 

机构地区：[1]辽宁省肿瘤医院头颈外科,辽宁沈阳110042

出　　处：《中国耳鼻咽喉头颈外科》2005年第2期69-71,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的前瞻性研究喉及喉咽鳞癌患者前哨淋巴结(sentinel Iymph node,SLN)的存在、位置、数量、阳性率及制定颈部治疗计划。方法30例术前未曾经过任何治疗的喉及喉咽鳞癌患者,临床颈部触诊及影像学检查均属于NO,均在原发灶周围黏膜下注射2毫升亚甲蓝液,在20-30分钟后于颈部检查染色淋巴结。其中5例在手术前日于相同部位注射1毫居里99m锝-右旋糖苷(1mci 99m Tc-Dx),分别于注射后30分、1小时和2小时应用发射型计算机断层扫描连续静态显像观察。6例在手术当中对SLN进行了冰冻活检。30例的前哨淋巴结、颈清标本及原发病灶,均行常规组织病理学检查。结果30例注射亚甲蓝患者中28例(占93.3%)发现染色的SLN。注射99m锝-右旋糖苷的5例患者,则100%在发射型计算机断层扫描连续静态显像中观察到SLN的核素图像。共查得前哨淋巴结49枚,平均每例1.6枚。其大多数位于Ⅱ或Ⅲ区,其中有5例共有6枚SLN被确定有转移,占全部病例的16.7%(5/30),5例中有3例在颈部其他部位同时发现转移淋巴结。结论喉及喉咽鳞癌SLN检出是一个有前途的预测方法,对于制定颈部治疗方针有指导意义,但尚需进一步研究和完善。OBJECTIVE A prospective study was carried out to determine whether there is any sentinel lymph node (SLN) in laryngeal and hypopharyngeal squa mous cell carcinoma, and also to determine its location, quantity and the positive rate of SLNs. METHODS Thirty previously untreated patients with laryngeal and hypopharyngeal squamous cell carcinoma without clinical evident metastasis were included in this study. 2 ml of methylene blue dye was injected peritumorally in all of 30 patients at 20 to 30 minutes before neck dissection. Five of those 30 patients were injected 1 mci 99m Tc-Dx at the same place 24 hours before operation. A static lymphoscintigraphy was performed 30 minute, 1 and 2 hours respectively after injection. Frozen section biopsy of the SLNs was performed in 6 patients. All SLNs in neck dissection specimens and primary tumor were examined by routine histopathol ogy examination. RESULTS Blue dye accurately identified SLNs in 28 of 30 patients (93.3 %). The static lymphoscintigraphy identified SLNs in all 5 patients (100 %). The mean number of SLNs in each patient was 1.6 (amount 49 SLNs in total). Most of the SLNs located in level Ⅱ and level Ⅲ. Six SLNs in 5 patients revealed metastases (16.7 %). Three of the 5 patients revealed positive lymph nodes in non-SLNs. CONCLUSION SLN biopsy examination could be a promising method for identifying metastastic lymph nodes in patients with NO laryngeal and hypopharyngeal squamous cell carcinoma. SLN is of some significance in guiding a policy of neck management. However, further study is needed.

关 键 词：SLN 前哨淋巴结 颈部 患者 注射 喉咽癌 鳞癌 临床 发射型计算机 断层扫描 

分 类 号：R739.6[医药卫生—肿瘤]