蓝染法定位CN_0舌癌前哨淋巴结的价值

Clinical value of the sentinel lymph node localization in tongue carcinoma with clinically negtive neck with dyed technique

目的:探讨蓝染法在CN0期舌鳞癌前哨淋巴结定位的应用价值。方法:对32例CN0舌鳞癌病例术中应用蓝染法定位前哨淋巴结,采用先翻开颈部皮瓣后再在病灶边缘注射亚甲蓝的方法,观察颈部淋巴结蓝染情况,计数发现淋巴结蓝染的时间及蓝染淋巴结数目,切取蓝染淋巴结送冰冻病理检查,然后完成颈清扫术,观察前哨淋巴结病检结果与术后颈部淋巴结常规病理检查结果的相关性,计算前哨淋巴结对CN0舌癌患者颈部淋巴结转移的预测价值。结果:32例中31例成功定位前哨淋巴结,定位成功率96.88%,从注射染料到出现淋巴结蓝染平均25min,每例平均定位前哨淋巴结1.9个,8例前哨淋巴结病理检查阳性,与术后常规病理检查对照未发现假阴性病例,前哨淋巴结对CN0舌癌颈淋巴结转移的阳性及阴性预测价值均为100%。结论:蓝染法定位CN0期舌鳞癌前哨淋巴结有较高的临床应用价值。

Objective： To investigate the clinical value of methylene blue dye mapping for detecting the sentinel lymph node （SLN） and prediicting the cervical lymph node metastasis in tongue carcinoma with clinical negative neck （CN0）. Method： Intraoperative methylene blue dye mapping were performed in 32 cases of tongue carcinoma with No to detect the SLN.First, the neck flaps were lifted; Sencond, local 0.2 ml 2% isosufan blue dye was submucously injected 0.5 cm away from the upper, lower, right and left margin of the primary tumor. The time of found the blue lymph node and the numbers of the blue lymph node were counted, Taking the blue lymph node for frozen pathological examination, Final, Neck dissection were performed.The results of the frozen pathologicexamination of SLN were compared with the results of the routine pathological examination of the cervical lymph nodes. The metastatic relation between the SLN and the cevical nodes as well as SLNs predictive value to the cervical nodes metastasis were analyzed.Result： SLN was successfully revealed in 31 of these 32 patients, The successful rate was 96.88%, The average time from the injection of isosufan blue dye to found the SLN was 25 minutes, averaging 1.9 SLN per patient, Sentinel lymph nodes were found with metastasis in 8 cases, No non- sentinell ymph node was found with metastasis while sentinel lymph nodes were pathologically negative.The positive and negative predicttive value of SLN to cervical metastasis in tongue carcinom with No were 100% .Conclusion： The sentinel lymph node localization in CN0 tongue carcinom with methylene blue dye has important clinical value.