分化型甲状腺癌30例前哨淋巴结临床探究.docVIP

分化型甲状腺癌30例前哨淋巴结临床探究[摘要] 目的:探讨分化型甲状腺癌前哨淋巴结的检测及其对颈淋巴结转移的预测价值。方法:采用亚甲蓝染色法,对30例分化型甲状腺癌患者进行前哨淋巴结活检,并行颈淋巴结清扫,将染色的前哨淋巴结和未染色的淋巴结分别送检,比较两者的病理学状况。结果:30例甲状腺癌患者中,24例显示了前哨淋巴结,平均每例2.6枚,14例为阳性,其敏感度、准确度、假阴性率分别为87.5%、80.0%、20.0%。结论:甲状腺癌前哨淋巴结检测能准确反映颈部淋巴结转移状况,对分化型甲状腺癌淋巴结转移的判断有重要的预测价值。 [关键词] 甲状腺肿瘤;前哨淋巴结;转移 [中图分类号] R736.1 [文献标识码]B[文章编号]1673-7210(2009)08(b)-153-02 Clinial study of the sentinel lymph of patients with differentiated thyroid carcinoma ZHANG Yihong, YU Qiufeng, MIAO Chaoliang (The Cancer Hospital of Liaocheng, Liaocheng 252000,China) [Abstract] Objective: To investigate the detecting methods of the sentinel lymph nodes of the differentiated thyroid carcinoma. Methods: In 30 cases who suffered from differentiated thyroid carcinoma, them ethylene blue was used to indentify the sentinel lymph nodes, and cervical node dissection was performed. The lymph nodes were dyed in blue and the other lymph nodes were examined respectively. Results: Of the 30 patients, sentinel lymph nodes in 24 patients were detected successfully. There were 2.6 lymph nodes per patient. The sensitivity, accuracy and false negative rates were 87.5%, 80.0% and 20.0%. Conclusion: The sentinel lymph node of thyroid carcinoma can accurately indicate the status of the cervical nodes. There is important predicted value in the cervical metastasis of the patients suffered from differentiated thyroid carcinoma. [Key words] Thyroid neoplasm; Sentinel node; Metastasis 分化型甲状腺癌(DTC)是指甲状腺乳头状癌、滤泡状癌和Hurthle细胞癌,其发展缓慢,病死率低,但颈淋巴结转移多,尤其以乳头状癌多见。对N0期的甲状腺癌的病例是否行同期颈淋巴结清扫有一定的争议。我院2006年10月～2007年12月对30例甲状腺癌进行了前哨淋巴结(SLN)的临床研究,现报道如下: 1 资料与方法 1.1 一般资料 全组30例中,男9例,女21例;年龄24～67岁,平均37.8岁。术后病理检查:乳头状癌23例,滤泡状癌7例。 1.2 N0期甲状腺癌的诊断标准 参照Kowalski等提出的颈淋巴结临床评价标准,同时符合下列条件者可诊断为N0期甲状腺癌:①临床检查未触及肿大淋巴结,或肿大淋巴结最大直径小于2 cm,质地柔软;②影像学检查未见肿大淋巴结,或肿大淋巴结最大直径小于1 cm,或最大直径1～2 cm,但无中心性液化坏死、周边强化和结旁脂肪间隙消失等;③缺乏影像学资料者以触诊为准。 1.3入组标准 ①临床颈部淋巴结阴性;②既往无颈部手术史和放疗史;③对染料和制剂无过敏史。 1.4 方法 切开皮肤、皮下组织,打开颈前肌群,在患侧腺体肿瘤周围多点注射亚甲蓝1～2 ml,10～15 mi