甲状腺乳头状癌前哨淋巴结的临床研究

Clinical significance of exploring the sentinel lymph nodes in patients with thyroid papillary carcinoma

目的:探讨甲状腺乳头状癌前哨淋巴结美蓝染色情况对选择甲状腺乳头状癌术式的影响。方法:对488例甲状腺疾病患者采用1%美蓝1.0～2.0ml术前24h注射于甲状腺结节或周围腺体,并在术中探查其颈部淋巴结蓝染数目及分布,同时对蓝染的淋巴结及切除的甲状腺结节行术中快速病理检查。结果:488例甲状腺疾病患者中甲状腺乳头状癌127例,蓝染淋巴结数目1208枚,占蓝染淋巴结的96.3%,其中有淋巴结转移占86.9%(1050/1208);甲状腺髓样癌6例,蓝染淋巴结数目46枚,占蓝染淋巴结的3.7%,淋巴结转移占87.0%(40/46);甲状腺滤泡癌10例、结节性甲状腺肿325例、桥本甲状腺炎20例,3组均未见蓝染淋巴结。结论:美蓝标定甲状腺乳头状癌前哨淋巴结的方法可行、可靠,与病理诊断符合率为86.9%,术中根据蓝染淋巴结的分布并结合快速病理诊断选择术式是较为合理的方法。

Objective To evaluate the clinical significance of exploring the sentinel lymph nodes in patients with thyroid papillary carcinoma. Methods Methyhhioninium chloride 1.0-2.0 ml was injected each in 488 patients with thyroid node before operative 24 hours, the number and distribution of the blue-stained nodes in the cervix were explored during operation, and the blue-stained nodes and resected thyroid nodes were examined by rapid pathology. Results In 127 cases of thyroid papillary carcinoma, the 1 208 blue-stained nodes were obtained, and 86.9% of them（ 1 050/1 208） were diagnosed as metastatic lymphadens. And in 46 blue-stained nodes obtained from 6 cases of thyroid medullary carcinoma,87.0% of them（40/46）were pathologically diagnosed as positive lymphonodus. There was no blue-stained nodes found in patients with thyroid follcular carcinoma, nodular goiter or Hashimoto＇s thyroiditis. Conclusions The method of staining lymphaden by methyhhioninium chloride is feasible and trustworthy, and its accurate diagnostic rate of pathology is 86.9 percent. The distribution of blue-stained lymphonodus and the results of rapid pathological examination are helpful for selecting operation program.