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目的评估舌鳞癌患者术前行前哨淋巴结免疫组化检测对确定术式及预后影响的临床意义。方法利用自动弹射活检装置在超声引导下对30例舌鳞癌颈部前哨淋巴结行穿刺活检术,穿刺物行细胞角蛋白(CK)抗体的免疫组化检测。阳性者行颈淋巴清扫术,术后淋巴结行常规病理切片;阴性者不行颈部手术,全部追踪随访2年,观察对比患者颈部淋巴结情况。结果30例中21例穿刺成功,10例呈CK阳性。淋巴结阳性分布:I区2例,II区5例,I区和II区2例,II区和III区1例;颈部淋巴结清扫术后常规HE染色检查结果与免疫组化检测结果一致(P>0.05);11例穿刺物呈阴性者未行颈部淋巴结清扫术,其中2例分别在术后3个月及6个月出现淋巴结肿大即行挽救性手术,另9例观察至今均未发现淋巴结肿大。结论对舌鳞癌患者术前行颈部淋巴结超声引导穿刺活检术并对穿刺物行CK蛋白检测,可提高舌鳞癌淋巴结转移诊断准确率,并在术前为患者及临床医师提供较为客观而准确的颈部淋巴结评估以确定较为恰当的治疗方式。
Objective To evaluate the clinical significance of preoperative detection of sentinel lymph node (SP) immunohistochemistry in determining the surgical procedure and prognosis of tongue squamous cell carcinoma patients. Methods Thirty patients with tongue squamous cell carcinoma of the neck sentinel lymph node biopsy under the guidance of ultrasound were detected by using automatic ejection biopsy. The cytokeratin (CK) antibody was detected by immunohistochemistry. Positive cervical lymph node dissection, postoperative lymph node routine pathology; negative neck surgery, all follow-up of 2 years, the observation of patients with cervical lymph nodes. Results Twenty-one of 30 cases were successfully punctured and 10 cases were positive for CK. Lymph node positive distribution: I in 2 cases, II in 5 cases, I and II in 2 cases, II and III in 1 case; conventional lymph node dissection after HE staining and immunohistochemical results are consistent (P > 0.05); 11 cases were negative with no punctures of neck lymph node dissection, 2 cases were swollen lymph nodes at 3 months and 6 months after operation, respectively, and salvage operation was performed in the other 9 cases Lymphadenopathy. Conclusion Preoperative cervical lymph node ultrasound-guided biopsy of tongue squamous cell carcinoma and detection of CK protein in laryngeal squamous cell carcinoma can improve the diagnostic accuracy of lymph node metastasis of tongue squamous cell carcinoma, and provide patients and clinicians with preoperative objectively Accurate assessment of cervical lymph nodes to determine the more appropriate treatment.