^99Tcm-右旋糖酐头颈部淋巴显像的临床价值

Detecting lymphatic drainage of head and neck squamous cell carcinoma with ^99Tcm-DX105 radionuclide lymphscintigraphy

目的探讨术前^99Tcm-右旋糖酐（DX105）头颈部淋巴显像对头颈部鳞状细胞癌患者术中淋巴结清扫的指导意义。方法41例头颈部鳞状细胞癌患者，临床诊断为Nn期，且未经治疗，术前均在双耳后乳突皮下注射^99Tcm-DX协，注射后10～90min行常规淋巴显像，在相应的颈部皮肤上标记显像“热点”，术中切除原发肿瘤后行头颈部淋巴结清扫，切除已经显影和未显影的淋巴结进行连续病理切片，用免疫组织化学法检查其是否为转移淋巴结。结果^99Tcm-DX105头颈部淋巴显像共显示Ⅰ～Ⅵ区淋巴结数目分别为30，63，58，36，29和20个，相应区域术中切除的淋巴结数目分别为64，67，71，56，16和0个。9例患者出现单侧或双侧淋巴链中断，病理学检查证实为转移，符合率为9／9。结论常规淋巴显像可显示头颈部大多数淋巴结的位置及淋巴链的功能状态，为头颈部肿瘤隐性转移的预测提供可靠依据，有助于术中确定淋巴结清扫范围。

Objective ＂Lymphatic＇drainage in head and neck region is abundant, This study used ^99Tcm-dextran （DX）105 radionuclide lymphscintigraphy in order to demonstrate the lymphatic drainage and lymph node status of head and neck squamous cell carcinoma. Methods Forty-one patients were diagnosed with squamous cell carcinoma of head and neck in stage N0. Radionuclide lymphscintigraphy images were acquired 10 -90 min after subcutaneous injection of ^99Tcm-DX105. The ＂ hot spots＂ found in radionuclide images were marked on the skin surface. The throughout resection of lymph nodes in head and neck region were performed after the primary tumor removed and histological evaluation undertaken for them, Results The number of lymph nodes in the 1st to 6th regions shown by lymphscintigraphy were 30, 63, 58, 36, 29 and 20, respectively. The numbers were close to, but less than, that removed in surgical operation. Nine patients with lymph node chains broken off in one or two levels were definitively proved to suffer metastasis, Conclusions Radionuclide lymphscintigraphy could provide evidence of lymphatic metastasis from squamous cell carcinoma in head and neck. It could also show the number and location of the lymph nodes so as to offer some help in surgical planning.