叶绿素染色在喉癌下咽癌颈淋巴结清扫术中的应用

Application of chlorophyll in the cervical lymph nodes dissection of laryngeal and hypopharyngeal carcinomas

目的 :探讨喉癌、下咽癌的颈淋巴结转移方式。方法 :对 5 0例喉癌、下咽癌患者于颈清扫术前 ,在喉及下咽粘膜下注射叶绿素使颈淋巴结系统染色 ,指导施行颈清扫术并收集淋巴结 ,进行连续切片观察。结果 :颈淋巴结被染成深绿色 ,与周围组织颜色对比明显 ,便于颈部手术和采集淋巴结 ;经病理检查证实 ,颈淋巴结总的转移率为 4 8% ,Ⅰ、Ⅴ区转移时均伴有其它区域的转移 ,Ⅱ、Ⅲ区转移率高于Ⅰ、Ⅳ、Ⅴ区 (P <0 .0 1) ;临床诊断颈淋巴结阴性 (cN0 )的患者淋巴结转移率为 2 3.5 % ,转移区域均在Ⅱ、Ⅲ区。结论 :临床诊断颈淋巴结阳性 (cN+ )喉癌、下咽癌患者的颈清扫手术 ,首先要保证清扫II、III区淋巴结 ,术中所见决定选择性颈清扫术式 ,对cN0 的下咽癌或声门上癌可行单侧或双侧颈深上、中淋巴结清扫术。叶绿素染色清晰 ,安全无毒 ,便于手术 。

Objective:To investigate the patterns of cervical lymph node metastases from the carcinomas of larynx and hypopharynx.Method: Chlorophyll solution was injected submucosally into some portions of the larynx and hypopharynx preoperately as a stain of lymphatic system to help conduct modified neck dissections in 50 patiants with laryngeal or hypopharyngeal carcinomas. Searial sections were performed.Result: The cervical lymph nodes were stained into deep green with a color contrast to the ambient structures,which facilitated the operation of neck dissections and the distinction of lymph nodes. Pathologically positive lymph nodes found in 48% of all the cases. The metastases to level I and V were always associated with other level's. By statisical analysis, there was a higher metastaic rate in level Ⅱ,Ⅲ,and Ⅴ(P< 0.01 ). Overal l occult metastases were recorded in 23.5 % of N 0 (clincally negative neck)cases. The involvement were located only at level Ⅱ or Ⅲ.Conclusion: For cN +(clinically positive neck) patiants, upper and middle jugular vein nodes should be dissected necessarilly,and then appropriate selective neck dissections might be considerd according to the intraoperative findings. For the cN o cases with supraglottic or hypopharyngeal carcinomas,it is suggested ipsilateral or bilateral upper and middle jugular vein nodes be dissected according to the clinical status. Chlorophyll as a kind of safe and disinctive stain of lymphatic system can be injected preoperatively routinely.