纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌颈淋巴清扫术中的应用  

Application of carbon nanoparticles as lymph node tracers in patients with c N0 lingual squamous cell carcinoma undergoing neck dissection

作　　者：李婷婷[1] 蒋灿华[1] 陈洁[1] 吴立萌 张瑞璞[1] 翦新春[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,长沙410008

出　　处：《华西口腔医学杂志》2016年第4期408-413,共6页West China Journal of Stomatology

基　　金：国家自然科学基金(81271154);中南大学临床科研基金(2015102)~~

摘　　要：目的：探讨纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌患者颈淋巴清扫术中的应用价值。方法选取96例cN0舌鳞状细胞癌患者作为研究对象，随机分为纳米炭组（试验组，50例）和对照组（46例），其中纳米炭组患者于术前12 h在距离肿块边缘0.5 cm处黏膜下多点注射纳米炭混悬注射液（每个注射点0.1 mL，共计3-4个注射点）。根据原发肿瘤的大小及部位选择行肩胛舌骨肌上（Ⅰ-Ⅲ区）或全颈（Ⅰ-Ⅴ区）淋巴清扫术。标本离体后解剖、分离所有淋巴结，并行病理学检查，记录检获的淋巴结数目、大小、部位、病理结果。将试验组与对照组所得数据进行比较，采用SPSS 19.0统计软件包进行统计学分析。结果31例患者行肩胛舌骨肌上颈淋巴清扫术，共检出淋巴结1137枚，纳米炭组平均每例检出淋巴结数（43.79±19.23）枚，显著高于对照组的（30.82±8.77）枚（P=0.019），两组均以Ⅲ区检出的淋巴结数最多，但纳米炭组Ⅱ区检出的淋巴结数及构成比均显著高于对照组（P=0.000）。65例全颈淋巴清扫术共检出淋巴结3938枚，纳米炭组平均每例检出淋巴结数为（66.67±20.02）枚，对照组为（53.03±20.98）枚，两组差异有统计学意义（P=0.026），两组在各区（Ⅰ-Ⅴ区）检出淋巴结数的构成比的差异无统计学意义（P=0.354）。两种颈淋巴清扫术式中，纳米炭组检出微小淋巴结的比例和检获淋巴结的准确率均高于对照组（P=0.000）；纳米炭组中染色淋巴结癌转移的检出率高于未染色的淋巴结（P=0.000）。结论纳米炭淋巴结示踪剂可以显著提高cN0舌鳞状细胞癌患者颈淋巴清扫术中淋巴结特别是微小淋巴结的检出率，有助于提高颈淋巴清扫术的彻底性和患者临床病理分期的准确性。ObjectiveThis study aimed to investigate the value of carbon nanoparticles as lymph node tracers in neck dissection for cN0 lingual squamous cell carcinoma patients.Methods Ninety-six patients with cN0 lingual squamous cell carcinoma were recruited to undergo surgical treatment were randomly divided into two groups, namely, the carbon nanoparticle-labeled group （the experimental group, 50 cases） and the control group （46 cases）. Carbon nanoparticle suspension was injected into the submucosal layer around the site of the primary tumor at three or four points （0.1 mL for each point） 12 h before surgery. Supraomohyoid neck dissection （SOHND, LevelsⅠ toⅢ） or comprehensive neck dissection （CND, LevelsⅠtoⅤ） were performed based on the size and location of the primary tumor. All the lymph nodes were dissected and separated from theex vivo surgical specimens for histopathological evaluation. The number, size, location, and pathological result of all the lymph nodes were compared between the two groups. Statistical analyses were conducted by SPSS 19.0 software. Results A total of 1 137 lymph nodes were detected in 31 SOHND patients. The average number of lymph nodes detected in the experimental group was （43.79±19.23） /case,which was significantly higher than that in the control group [（30.82±8.77） /case] （P=0.019）. LevelⅢ covered the largest number of lymph nodes in the two groups. However, the number and proportion of lymph nodes found in LevelⅡ of the experimental group were significantly higher than those of the control group （P=0.000）. A total of 3 938 lymph nodes were detected in 65 CND patients. The average number of lymph nodes detected in the experimental group [（66.67±20.02） /case] was larger than that in the control group [（53.03±20.98） /case] （P=0.026）. The difference in the lymph node location between the two groups was not statistically significant （P=0.354）. In the two neck dissection methods, both the proportion of minute lymph nodes and t

关 键 词：舌鳞状细胞癌 颈淋巴清扫术 纳米炭 淋巴结示踪剂 

分 类 号：R739.86[医药卫生—肿瘤]