临床N_0喉癌和下咽癌患者前哨淋巴结的分布  

Distribution of sentinel lymph node in patients with cN_0 laryngeal and hypopharyngeal carcinomas

作　　者：程艳[1] 王斌全[2] 温树信[2] 

机构地区：[1]山西医科大学第一医院核医学科,太原030001 [2]山西医科大学第一医院耳鼻咽喉科,太原030001

出　　处：《中国药物与临床》2009年第5期361-363,共3页Chinese Remedies & Clinics

基　　金：国家自然科学基金(30772405)

摘　　要：目的通过前哨淋巴结(SLN)显像,分析临床N0(cN0)喉癌和下咽癌的SLN分布特点,探讨合理的颈清扫手术方式。方法36例cN0喉癌患者和8例cN0下咽癌患者手术前进行显像,同时术中用γ探针探测放射性"热点"进行SLN定位。结果36例喉癌患者SLN检出率为92%(33/36)。声门上型、声门型和贯声门型喉癌患者的SLN位于Ⅱ区和Ⅲ区,声门下型位于Ⅵ区。声门上型SLN检出率为95%(18/19),Ⅲ区SLN检出率为60%(21/35),Ⅱ区SLN检出率为40%(14/35)。声门型SLN检出率为87%(13/15),Ⅲ区SLN检出率为88%(14/16),Ⅱ区SLN检出率为13%(2/16)。8例下咽癌患者SLN检出5例。下咽癌患者的SLN位于一侧Ⅱ区、Ⅲ区和Ⅵ区。结论对cN0声门上型和声门型喉癌重点行Ⅲ区和Ⅱ区术中冰冻,对cN0下咽癌重点行Ⅱ区、Ⅲ区和Ⅵ区术中冰冻,根据结果决定是否行相应区域的淋巴结清扫术是切实可行的。Objective To study the distribution of cervical sentinel lymph node （SLN） in patients with clinically neck-negative （cN0） laryngeal and hypopharyngeal carcinomas by SLN imaging and to elucidate which levels should be involved during neck dissection. Methods Thirty-six patients with cNo laryngeal carcinoma and 8 patients with cN0 hypopharyngeal carcinoma underwent pre-surgical SLN imaging. All patients received intraoperative lymphatic mapping with a portable gamma-detecting probe scanning for ＂hotspots＂. Results In laryngeal carcinoma, SLN was detected in 92% （33/36） of patients, with involvement of levels Ⅱ and Ⅲ lymph nodes by supraglottic, glottie and transglottic lesions, and level Ⅵ by hypoglottic lesions. Specifically, SLN was detected in 95% （18/19） of patients with supraglottie cancer, involving 60%（21/35） of level m and 40% （14/35） of level Ⅱ lymph nodes. The detection rate of SLN was 87% （13/15） in glottic cancer, involving 88% （14/16） of level Ⅲ and 13% （2/16） of level Ⅱ lymph nodes. The detection of SLN was patients among patients with hypopharyngeal carcinoma, with involvement of levels Ⅱ, Ⅲ and Ⅵ lymph nodes. Conclusion Pathological studies with frozen sections should be prompted for SLNs involving levels Ⅲ and Ⅱ lymph nodes in supraglottic and glottic cN0 cancers and those involving levels Ⅲ, Ⅱ and Ⅵ lymph nodes in hypopharyngeal cNo cancers. Decision to perform a neck dissection based on this practice should be reliable for the treatment cN0 laryngeal and hypopharyngeal carcinomas.

关 键 词：喉肿瘤 下咽肿瘤 前哨淋巴结活组织检查 

分 类 号：R739.6[医药卫生—肿瘤]