胰头癌切除标本淋巴结检出方法的比较

Comparison of different methods for detecting lymph nodes from surgically resected specimens of pancreatic head carcinoma

目的 寻找一种简便、全面的检出胰头癌根治性术后标本中淋巴结的方法 ,以有利于准确评定其病理分期。方法 对 4 2例根治性切除术后的胰头癌标本分别采用常规病理取材法、手术显微镜法、清洗法和简化连续切片法寻找或鉴别淋巴结 ,并进行比较。结果 清洗法和简化连续切片法操作繁复、费时 ,不适合实际应用。手术显微镜法所找到的淋巴结数约为常规病理取材法的 3倍。 2 4例采用手术显微镜法寻找淋巴结的胰头癌标本中 ,证实 17例伴有淋巴结转移 (转移率为 70 .8% ) ,而常规病理取材法组证实的转移率为 5 0 % (P<0 .0 1)。并且淋巴结转移和淋巴结大小无关 ,在发生转移的淋巴结中 <5 mm的淋巴结占 37.2 %。结论 手术显微镜法是一种简便、经济、有效的方法。

Objective To find a simple and effective method for improving the yielding rate of lymph nodes from surgically resected specimens of pancreatic head carcinoma for more precise pathological staging.Methods Four different methods including the routine pathology method,operating microscope method,clearing method and simplified consecutive section method were respectively applied to 42 specimens after radical resection of pancreatic head carcinoma. The results were compared and statistically analyzed,and the efficiency and feasibility of the four methods were discussed.Results The mean number of lymph nodes detected per patient was 37.7 for the operating microscope method,which was about 3 times that for the routine pathological method (13.7 per patient). Of 24 cases by using both the operating microscope method and the routine pathology method,lymph node metastasis was detected in 17 cases (70.8%) and 12 cases (50%) respectively. Of all lymph nodes metastasis,37.2% lymph nodes were less than 5 mm in diameter. There was no correlation between lymph node metastasis and size of the lymph nodes.Conclusions The operating microscope method is a simple,economical and effective method for detection of lymph nodes metastasis.