联合运用核素法和染料法检测cN_0期喉癌及下咽癌前哨淋巴结的临床意义  

The clinical value of sentinel lymph node detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck by methylene blue method and radiolabeled tracer method

作　　者：赵新[1] 肖大江[1] 倪建明[1] 朱国臣[1] 袁渊[1] 徐婷[1] 张永胜[1] 

机构地区：[1]无锡市第二人民医院耳鼻咽喉科,江苏无锡214002

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第21期1652-1654,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:运用染料法、核素法以及两者联合法检测cN0期喉癌及下咽癌前哨淋巴结(SLN),评价SLN对颈部淋巴结转移状况的预测价值。方法:33例喉癌和6例下咽癌患者采用染料法、核素法及两者联合法检测SLN。染料法为术中全身麻醉下注射亚甲蓝,检测蓝染的SLN;核素法为术前注射99m锝-硫胶体,术中用γ-探针探测高能核素浓集的淋巴结;联合法为染料法、核素法联合运用。SLN全部切除后行相应的喉切除加选择性颈淋巴结清扫术,所有淋巴结送常规病理检查。结果:染料法、核素法以及联合法对SLN的检出率分别为79.5%、89.7%、92.3%,核素法、染料法与联合法SLN检出率比较,均差异有统计学意义(均P<0.05)。病理结果显示39例患者中,术后常规病理切片发现转移9例(23.1%)。联合法检出SLN的灵敏度、准确率、假阴性率分别为88.9%、97.2%、11.1%。结论:联合运用染料法和核素法提高了SLN的检出率和正确率,SLN的病理结果比较准确地反映出cN0喉癌和下咽癌患者颈部淋巴结的病理状态,该技术具有良好的临床应用前景。Objective：To investigate the clinical value of sentinel lymph node（SLN）detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck（cN0）by methylene blue method,radiolabeled tracer method and combination of these two methods.Method：Thirty-three patients with cN0 laryngeal carcinoma and six patients with cN0 hypopharyngeal carcinoma underwent SLN detection using both of methylene blue and radiolabeled tracer method.All these patients were accepted received the injection of radioactive isotope 99 Tcm-sulfur colloid（SC）and methylene blue into the carcinoma before surgery,then all these patients underwent intraopertive lymphatic mapping with a handheld gamma-detecting probe and blue-dyed SLN.After the mapping of SLN,selected neck dissections and tumor resections were peformed.The results of SLN detection by radiolabeled tracer,dye and combination of both methods were compared.Result：The detection rate of SLN by radiolabeled tracer,methylene blue and combined method were 89.7%,79.5%,92.3%respectively.The number of detected SLN was significantly different between radiolabeled tracer method and combined method,and also between methylene blue method and combined method The detection rate of methylene blue and radiolabeled tracer method were significantly different from combined method（P〈0.05）.Nine patients were found to have lymph node metastasis by final pathological examination.The accuracy and negative rate of SLN detection of the combined method were 97.2%and 11.1%.Conclusion：The combined method using radiolabeled tracer and methylene blue can improve the detection rate and accuracy of sentinel lymph node detection.Furthermore,sentinel lymph node detection can accurately represent the cervical lymph node status in cN0 laryngeal and hypopharyngeal carcinoma.

关 键 词：喉肿瘤 下咽肿瘤 前哨淋巴结 亚甲蓝 

分 类 号：R739.6[医药卫生—肿瘤]