淋巴结冰冻病理活检在肾癌根治术中的应用

目的：探讨肾癌根治术中淋巴结快速冰冻切片的临床价值。方法回顾分析首都医科大学附属北京世纪坛医院1995年1月至2014年1月650例肾癌根治术病例,157例进行了区域性淋巴结清扫,120例发现肿大淋巴结,36例术中行淋巴结冰冻切片,比较有无淋巴结肿大者的实际淋巴结的转移率,及术中冰冻病理与术后石蜡病理的吻合情况。结果120例发现肿大淋巴结患者中27例术后证实有淋巴转移；36例术中送肿大淋巴结快速冰冻病理检查,8例（22.2%）提示有转移淋巴结,28例（77.8%）提示淋巴结炎性反应。8例提示淋巴结转移的患者中2例术后病理发现其他淋巴结转移。28例提示淋巴结炎性反应的患者中仅1例术后提示淋巴结转移。结论对于有淋巴结肿大的肾癌患者,根据术中冰冻结果决定是否行淋巴结清扫术,具有重要的临床意义。

Use of lymph nodes frozen section pathology in radical nephrectomy

Objective To evaluate the clinical application of lymph nodes frozen section pathology in radical nephrectomy. Methods We retrospectively analyzed the clinical data of 650 patients who underwent radical nephrectomy from January 1995 to January 2014 in our hospital, 157 patients underwent lymph nodes dissection; enlarged lymph nodes were found in 120 patients; 36 patients underwent lymph nodes frozen section pathology during surgery. Real lymph node metastasis rate was compared between the cases with and without lymph nodes enlargement frozen pathology and paraffin pathology were compared. Results Of the 120 patients in whom enlarged lymph nodes were found, 27 patients had lymph node metastasis. Of the 36 patients who underwent lymph nodes frozen section pathology during surgery, specimens of 8 patients（22. 2% ） showed lymph nodes metastasis, and other 28 patients（77. 8% ） had inflammation of lymph nodes. In 2 of the 8 patients whose frozen pathology suggested lymph nodes metastasis it was proved by paraffin pathology after surgery that their other lymph nodes had metastasis, only one of the 28 patients who showed inflammation of lymph nodes by frozen pathology, proved by paraffin pathology after surgery that there was lymph nodes metastasis. Conclusion For the patients who has renal cell carcinoma with enlarged lymph nodes, use of frozen section pathology of lymph nodes to decide whether lymph nodes dissection is needed is clinically important.