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目的:探索检测喉癌颈淋巴结微转移的敏感而可行的方法。方法:对20例声门上型喉癌患者原发部位及其182个颈淋巴结,按颈淋巴结清扫各区分别进行研究。检测手段包括:常规苏木精-伊红染色,角蛋白CK19免疫组化分析。对患者进行3~5年随访,对比其阳性率对患者颈淋巴结转移及预后的相关关系及总体生存率的比较。结果:发现喉鳞状细胞癌原发组织CK19阳性率100%;CK19颈淋巴结阳性率23.6%,常规苏木精-伊红颈淋巴结阳性率16.9%;苏木精-伊红检测在Ⅱ、Ⅲ区分别发现颈淋巴结转移为86.7%,13.3%,CK19在Ⅱ、Ⅲ、Ⅳ区发现颈淋巴结转移为88.4%,9.3%及2.3%。统计学分析,两者阳性率有显著差异,各区颈清扫淋巴结组织阳性率有显著差异,以颈淋巴结清扫Ⅱ区阳性率最高。总体生存时间与2种检测手段分析(LogRank检测),CK19检测的颈淋巴结转移与生存时间的下降有密切相关性,P<0.01,而苏木精-伊红检测无相关性。结论:角蛋白CK19免疫组化分析可认为是声门上型喉癌颈淋巴结微转移的有效检测手段,且较高的检出率与患者的生存时间的下降有密切相关性。
Objective: To explore the detection of cervical lymph node micrometastasis in sensitive and feasible method. Methods: The primary site of 20 cases of supraglottic laryngeal carcinoma and its 182 cervical lymph nodes were studied by cervical lymph node dissection. Detection methods include: conventional hematoxylin-eosin staining, CK19 immunohistochemical analysis. The patients were followed up for 3 to 5 years, compared with the positive rate of cervical lymph node metastasis and prognosis of patients and overall survival rate comparison. Results: The positive rate of CK19 in primary laryngeal squamous cell carcinoma was 100%. The positive rate of cervical lymph node in CK19 was 23.6%. The positive rate of common hematoxylin-eosin neck lymph node was 16.9%. The detection rate of hematoxylin-eosin in Ⅱ, The cervical lymph node metastasis was found to be 86.7% and 13.3% respectively. CK19 showed 88.4%, 9.3% and 2.3% of cervical lymph node metastases in stages Ⅱ, Ⅲ and Ⅳ. Statistical analysis, the positive rate of the two were significantly different, the positive rate of cervical lymph node dissection in each area were significantly different, the highest positive rate of cervical lymph node dissection II. There was a close correlation between overall survival time and analysis of two detection methods (LogRank test), cervical lymph node metastasis detected by CK19 and decline of survival time, P <0.01, but no correlation between hematoxylin and eosin. Conclusion: The immunohistochemical analysis of cytokeratin CK19 can be considered as an effective detection method for cervical lymph node micrometastasis in supraglottic laryngeal carcinoma. The higher detection rate is closely related to the decline of patients’ survival time.