淋巴显像法与染料法示踪喉癌和下咽癌前哨淋巴结的对比研究

A comparative study of sentinel lymph node detection in laryngeal and hypopharyngeal carcinoma by lymphoscintigraphy method and blue dye

目的探讨淋巴显像法与生物活性染料定位法示踪cN0期喉癌和下咽癌前哨淋巴结（sentinel lymphnode，SLN）在头颈部肿瘤治疗中的价值。方法40例cN0喉癌患者和10例cN0下咽癌患者，术前于喉镜引导下注射^99Tc^m-硫胶体，使用单光子发射型计算机断层扫描仪（single photon emission computed tomography，SPECT）和CT进行颈淋巴显像；同时术中用叮探针探测放射性“热点”。手术中注射亚甲蓝，示踪蓝染的SLN。SLN全部被切除后，行肿瘤切除加颈淋巴清扫术，所有淋巴结送常规病理检查。结果运用淋巴显像法35例喉癌和6例下咽癌患者检出SLN，检出率为82．0％（41／50）。运用生物活性染料定位法29例喉癌和4例下咽癌患者示踪SLN，检出率为66．0％（33／50），两种方法的检出率差异有统计学意义（Х^2．769，P〈0．05）。SLN的检出数目分别为96枚和83枚（Х^2=2．098，P〈0．05），灵敏度分别为83．3％和66．7％。本组50例患者中，12例患者常规病理检查有淋巴转移，占24．0％。结论淋巴显像法和染料法均可示踪cN0期喉癌和下咽癌的前哨淋巴结。淋巴显像法不仅术前可进行前哨淋巴结的定位，而且较染料法具有较高的检出率和灵敏度。

Objective To investigate the clinical value of sentinel lymph node（SLN） detection in laryngeal and hypopharyngeal carcinoma patients with clinically negative neck （cN0） by lymphoscintigraphy method and blue dye. Methods Forty patients with cN0 laryngeal neoplasms and ten patients with cN0 hypopharyngeal carcinoma scheduled for tumor resection and neck dissection, were eligible for the study. single photon emission computed tomography （SPECT）/CT lymphoscintigraphy was performed with injection of radioactivity isotope ^99Tc^m labeled sulfur coUoid（ ^99Tc^m-SC）. Methylthioninium was injected into the same points as ^99Tcm-SC during surgery, and the patients underwent lymphatic mapping with a handheld gammadetecting probe. All removed lymph nodes were examined by routine histopathology. Results Thirty-five patients with laryngeal carcinoma and six patients with hypopharyngeal carcinoma detected SLN by radiolabeled tracer method, the detection rate of SLN was 82. 0%. Tnenty-nine patients with laryngeal carcinoma and 4 patients with hypopharyngeal carcinoma detected SLN by blue dye method, the detection rate of SLN was 66. 0%. There were significant difference between two groups （X2 =2. 769,P 〈0. 05）, and the number of SLN were respectively 96 and 83 by radiolabeled tracer method and blue dye （ X^2 = - 2. 098, P 〈 0. 05 ） , The sensitivity of SLN detection were respectively 83.3% and 66. 7%. Twelve （ 24. 0% ） patients had lymph node metastasis. Conclusions Either lymphoscintigraphy or blue dye mapping can be used to detect the SLN in cN0 laryngeal and hypopharyngeal carcinoma. The lymphoscintigraphy not only preoperatively can locate the accuracy of SLN detection, but also has higher detection rate and sensitivity than dye method.