CAJ | 학술논문

目的探讨下颌牙龈鳞状细胞癌颈部淋巴结转移分布的特点,为颈淋巴结清扫术式的选择提供参考.方法选取下颌牙龈癌患者42例,女性15例,男性27例,年龄27～ 77岁,平均54.1岁.依据国际抗癌联盟2002年临床分期标准进行临床分期,T1期9例、T2期16例、T3期6例、T4期11例;并遵循美国耳鼻咽喉头颈外科学会1991年制定公布的颈部淋巴结Level分区.采用以鼠抗人细胞角蛋白单克隆抗体第一抗体的免疫组化法与HE染色病理检查进行对比研究.结果 42例患者取颈部淋巴结585个.所有HE染色阳性的切片,CK免疫组化均为阳性;常规HE染色和连续切片HE染色淋巴结阳性率分别为8.0％(47/585)和9.6％(56/585),免疫组化法阳性率为12.8％(75/585);常规HE染色和免疫组化检测淋巴结阳性率差异有统计学意义(x2=7.17,P＜0.01),连续切片和免疫组化检测阳性率差异无统计学意义(x2=3.10,P＞0.05).转移主要发生在Level Ⅰ、Ⅱ和Ⅲ区,晚期患者连续切片HE染色和免疫组化都有LevelⅣ区阳性淋巴结.免疫组化CK标记法12例患者的19个淋巴结内查及微转移灶,连续切片和常规HE染色均未查到微转移灶.结论 CK标记提高了牙龈癌的淋巴结转移检出率,对预后判断和临床治疗具有重要的指导意义,早期患者颈清术式可选择以清扫LevelⅠ、Ⅱ、Ⅲ区为主的肩胛舌骨上清扫,晚期患者清扫范围应扩大到LevelⅣ区.
목적 탐토하합아간린상세포암경부림파결전이분포적특점,위경림파결청소술식적선택제공삼고.방법 선취하합아간암환자42례,녀성15례,남성27례,년령27～ 77세,평균54.1세.의거국제항암련맹2002년림상분기표준진행림상분기,T1기9례、T2기16례、T3기6례、T4기11례;병준순미국이비인후두경외과학회1991년제정공포적경부림파결Level분구.채용이서항인세포각단백단극륭항체제일항체적면역조화법여HE염색병리검사진행대비연구.결과 42례환자취경부림파결585개.소유HE염색양성적절편,CK면역조화균위양성;상규HE염색화련속절편HE염색림파결양성솔분별위8.0％(47/585)화9.6％(56/585),면역조화법양성솔위12.8％(75/585);상규HE염색화면역조화검측림파결양성솔차이유통계학의의(x2=7.17,P＜0.01),련속절편화면역조화검측양성솔차이무통계학의의(x2=3.10,P＞0.05).전이주요발생재Level Ⅰ、Ⅱ화Ⅲ구,만기환자련속절편HE염색화면역조화도유LevelⅣ구양성림파결.면역조화CK표기법12례환자적19개림파결내사급미전이조,련속절편화상규HE염색균미사도미전이조.결론 CK표기제고료아간암적림파결전이검출솔,대예후판단화림상치료구유중요적지도의의,조기환자경청술식가선택이청소LevelⅠ、Ⅱ、Ⅲ구위주적견갑설골상청소,만기환자청소범위응확대도LevelⅣ구.
Objective To examine the cytokeratin expression in cervical lymph nodes of patients with mandibular gingival squamous cell carcinoma and its clinical significance.Methods The data of 42 cases with mandibular gingival squamous cell carcinoma after operation from July 2009 to December 2012 were included.Forty-two patients (male=27,formale=15) were included,with a mean age of 54.1 years (range 27-77).The lesions were staged(stage Ⅰ:9,stage Ⅱ:16,stage Ⅲ:6,stage Ⅳ:11).The cervical lymph nodes were examined by immunohistochemistry and HE.The cytokeratin expression in the lymph nodes was analyzed.Results The rates of lymph nodes metastasis detected by routine HE staining,serial sections HE staining and IHC were 8.0％(47/585),9.6％(56/585) and 12.8％ (75/585),respectively.There was significant difference (x2=7.17,P＜0.01) in the diagnosis of lymph nodes metastasis between IHC and routine HE staining,There was no significant difference between IHC and serial HE staining (x2=3.10,P＞0.05).Metastasis occurred mainly in the Level Ⅰ,Ⅱ and Ⅲ.Nineteen lymph nodes in 12 patients were found micrometastasis with IHC.Serial sections and routine HE staining did not find micrometastasis.Conclusions CK markers is sensitive in detecting lymph node metastasis of mandibular gingival squamous cell carcinoma.