口腔癌前哨淋巴结显像与术中γ探测

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 ^99Tc^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SLN γ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.

The lymphoscintigraphy and intraoperative gamma detection of sentinel lymph node in oral cavity carcinoma

Objective To evaluate the role of lymphoscintigraphy and intraoperative gamma probe detection of sentinel lymph node (SLN) in oral cavity carcinoma.Methods ~(99)Tc~m labeled dextran (DX) was injected submucously at the center of oral cavity carcinoma before operation.The SLN identified by lym- phoscintigrapby and intraoperative gamma counter probe were dissected out from the exited tissue.All senti- nel and other lymph nodes were sent for pathological examination.Results In all 33 cases.SLN and other lymph nodes were clear identified by lymphoscintigraphy.Forty-three SLNs were seen,among them 1 in 25 cases,2 in 6 cases and 3 in 2 cases.Metastases were detected by biopsy in SLN in 9 cases,however,11 cases showed positive neck lymph node matastases.The sensitivity of SLN gamma detection was 100% and in biopsy sensitivity was 81.82%,accuracy was 93.94%,false positive rate was 0,and false negative rate was 18.18%.Conclusions Intraoperative gamma probe detection is the reliable approach to identify SLN in oral cavity carcinoma.Lymphoscintigrapby is the base of localization for oral cavity carcinoma.