前哨淋巴结冰冻切片在口腔癌颈淋巴结清扫术的应用研究  

Sentinel Lymph Node Labeling Biopsy in Neck Dissection of OSCC

作　　者：刘弦 易杰[2] 胡小华[2] 姚礼[2] 张霓霓[2] 黄桂林[2] LIU Xian;YI Jie;HU Xiao-hua;YAO Li;ZHANG Ni-ni;HUANG Gui-lin(Department of Oral and Maxillofacial Surgery,Guiyang Municipal Hospital of Stomatology,Guiyang 55000;Department of Oral and Maxillofacial Surgery,Hospital of Stomatology,Zunyi Medical College,Zunyi 563003,Guizhou Province,China)

机构地区：[1]贵阳市口腔医院口腔颌面外科,贵州贵阳550002 [2]遵义医学院附属口腔医院口腔颌面外科,贵州遵义563003

出　　处：《口腔颌面外科杂志》2018年第2期80-84,共5页Journal of Oral and Maxillofacial Surgery

基　　金：遵义市科技局科研基金资助项目[遵市科合社字(2013)33号];遵义医学院硕士启动基金(F-618)

摘　　要：目的:利用术中靶动脉灌注亚甲蓝定位前哨淋巴结(SLN),同时进行冰冻切片检查,为颈淋巴结清扫范围提供参考。方法:对16例初诊诊断为cN0的口腔鳞癌患者,在经一个周期的靶动脉持续灌注抗癌药物诱导化疗后进行手术,术中经靶动脉灌注亚甲蓝。将蓝染的SLN纵向剖成两半,一半术中冰冻,检查肿瘤有无淋巴结转移;另一半SLN及术后所有的颈淋巴结行石蜡包埋,连续切片后行HE及CK19、CK(AE1/AE3)免疫组织化学检查。并对结果进行比较分析。结果:16例患者的40枚SLN中,冰冻检查发现2例患者的2枚SLN阳性,与术后HE、CK免疫组织化学染色连续切片检查结果相符。其余14例患者的32枚SLN术中冰冻、HE检查阴性,CK免疫组织化学染色检查发现2枚SLN存在微转移灶。所有术中冰冻检查阴性的38枚SLN中,36枚经HE、CK免疫组织化学染色检查均为阴性。SLN转移阳性4例,阳性率25%(4/16);SLN假阴性率为12.5%(2/16);总符合率87.5%(14/16)。结论:靶动脉灌注亚甲蓝定位SLN的术中冰冻诊断,可能成为口腔鳞癌颈淋巴清扫术的依据。Objective: To study the possibility of guidance of neck dissection through positioning sentinel lymph node(SLN) by targeting arterial infusion of methylene blue and taking intraoperative frozen section, and to provide references for the dissection range of lymph node. Methods: 16 patients, initially diagnosed as clinical N0(cN0) oral squamous cell carcinoma (OSCC), were taken one period of preoperative target arterial continuous infusion of anti-cancer agents for induction chemotherapy, then their blue stained SLN were cut into two (one for taking intraoperative frozen section and the other was embedded in paraffin) after taking target arterial infusion of methylene blue, to examine the lymphatic metastasis. The paraffin-embedded SLN were taken serial sections, stained by HE and CK19, CK (AE1/AE3) immunohistochemically, and their results were compared. Results: 40 SLN were detected in 16 patients. The intraoperative frozen section of 2 SLN in 2 patient was positive with OSCC, and the serial section results of postoperative HE and CK immunohistochemical staining presented positive as well. The intraoperative frozen section and HE examination results of the remaining 32 SLN of the other 14 patients were negative, and 2 SLN micrometastase was detected by CK immunohistochemical staining. Among the 38 SLN which presented negative through intraoperative frozen section, 36 were negative by HE and CK immunohisto chemical staining. 4 patients were detected positive in SLN metastases, with the positive rate of 25%(4/16), the false negative rate of 12.5%(2/16), and the total coincidence rate of 87.5%(14/16). Conclusion: The SLN intraoperative labeling biopsy examination can guide the neck dissection for patients with oral squamous cell carcinoma.

关 键 词：靶动脉灌注 亚甲蓝 前哨淋巴结 冰冻切片 颈淋巴清扫术 

分 类 号：R856.78[医药卫生—航空、航天与航海医学]