喉癌喉咽癌哨位淋巴结的临床初步研究

Clinical study of the sentinel lymph node of patients with laryngeal and hypopharyngeal carcinomas

目的 探讨喉癌喉咽癌哨位淋巴结的检测及其对颈淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法 ,对 2 9例颈淋巴结N0的喉癌喉咽癌患者进行了哨位淋巴结的临床研究。手术中取蓝染的哨位淋巴结作快速冰冻病理检查 ,并与HE染色病理检查结果及颈清扫切除的淋巴结病理检查对照 ,观察哨位淋巴结转移对颈淋巴结转移癌的预测值。结果 2 9例中 2 8例成功地显示了哨位淋巴结 ,成功率达 96 .6 %。每例发现蓝染的哨位淋巴结 1～ 4个 ,平均每例每侧检出 2 .5个。有 3例患者的哨位淋巴结检测有肿瘤转移 ,HE染色病理检查及颈清扫切除的淋巴结病理检查均证实颈淋巴结转移。 2 5例哨位淋巴结冰冻病理检查阴性患者 ,颈淋巴结清扫标本亦未查见淋巴结转移。哨位淋巴结对颈淋巴结转移的阳性预测正确率和阴性预测率均为 10 0 %。

Objective To investigate the methods of detecting the sentinel lymph node of laryngeal and hypopharyngeal carcinomas and its predictive value in the cervical metastasis of the carcinoma. Methods In 29 patients who suffered from laryngeal or hypopharyngeal carcinoma with N0 neck, the patent blue was injected into the surrounding tissue of the tumor during the operation to identify the sentinel lymph nodes. The sentinel lymph nodes were dyed blue. The frozen histopathology was done during the operation, the lymph nodes at the ipsilateral side of the neck were dissected completely, and the routine histopathology was done as the gold standard to study the predictive value of the sentinel lymph node in the metastasis of the cervical node. Results Of 29 patients, 28 patients′ sentinel lymph nodes were detected successfully during operation. There was an average of 2.5 lymph nodes per side per patient. Most of the sentinel lymph nodes were in the level Ⅱ and level Ⅲ regions of the ipsilateral side of the neck, and there were bilateral sentinel nodes in patients suffered from superglottic carcinoma. Three patients′ sentinel lymph nodes were found to be positive in the frozen inspection, and the routine histopathology confirmed the result. The micrometastasis rate was 10.7%(3/28). There were no metastatic lymph nodes found in patients who were negative for the sentinel lymph nodes during the operative frozen histopathology. The predicted value of the sentinel lymph nodes to the cervical lymph node metastasis was 100 per cent. Conclusion There is a very important predicted value of sentinel lymph nodes in the cervical metastasis of patients suffered from laryngeal and hypopharyngeal carcinomas. It could reduce the neck dissection in patients withlaryngeal and hypopharyngeal carcinomas.