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目的探讨淋巴显像及术中γ探测定位活组织检查口腔癌前哨淋巴结(SLN)的临床价值。方法术前在口腔肿瘤表面正中黏膜内(舌癌于肿瘤远心端边缘)注射37～74 MBq~(99)Tc~m-右旋糖酐(DX),行淋巴显像及术中γ探测定位口腔癌 SLN,术中切除 SLN,并行常规颈淋巴结清扫术。将切除的口腔肿瘤及淋巴结行病理检查,分析 SLN 和远端淋巴结转移的关系。结果 33例患者口腔癌 SLN 及淋巴引流显像清晰,共检出 SLN 43枚,其中1枚者25例,2枚者6例,3枚者2例。SLN病理检查结果有转移者9例,颈清扫淋巴结转移者共11例,2例 SLN 阴性而远处淋巴结转移,1例仅有 SLN 转移。口腔癌 SLNγ探测定位检出率100%。SLN 活组织病理检查灵敏度为81.82%(9/11例),准确性为93.94%,假阴性率为18.18%(2/11例),假阳性率为0。结论淋巴显像是定位口腔癌 SLN 的基础,术中γ探测是定位口腔癌 SLN 的可靠手段。
Objective To investigate the clinical value of lymphoscintigraphy and intraoperative γ detection for localization of sentinel lymph node (SLN) in oral cancer. [Methods] 37 ~ 74 MBq ~ (99) Tc ~ m-dextran (DX) were injected into the median mucosa of the oral tumor surface (tongue cancer at the distal end of the tumor) preoperatively. Lymphoscintigraphy and intraoperative γ- SLN, intraoperative resection of SLN, conventional neck lymph node dissection. The resected oral cancer and lymph nodes were examined by pathology, and the relationship between SLN and distal lymph node metastasis was analyzed. Results Twenty-three SLNs were detected in 33 patients with SLN and lymphatic drainage. Among them, there were 25 cases with one case, 6 cases with 2 cases and 2 cases with 3 cases. SLN pathological examination results in 9 cases of metastasis, cervical lymph node metastasis in 11 cases, 2 cases of SLN-negative and distant lymph node metastasis, only 1 case of SLN metastasis. Oral cancer SLNγ detection detection rate of 100%. The sensitivity of SLN biopsy was 81.82% (9/11), the accuracy was 93.94%, the false negative rate was 18.18% (2/11) and the false positive rate was 0. Conclusion Lymphoscintigraphy is the basis of localization of SLN in oral cancer. Intraoperative γ detection is a reliable method to locate SLN of oral cancer.