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頭頸外科論文喉癌喉部分切除術中切緣病理檢查的意義
【摘要】目的 探討喉癌喉部分切除術中切緣冷凍切片病理檢查的臨床意義。方法 以我院2000年1月～2003年10月間60例喉部分切除的喉癌聲門型病人為觀察對象;全部病例術前病理診斷為鱗狀細胞癌。行喉裂開患側聲帶、室?guī)谐?7例，行垂直半喉切除40例，行垂直半喉加額側切除3例，同期行頸淋巴結清掃11例。術中在距腫瘤邊緣3、5 mm切緣處分別選多點切取組織600份標本行快速冷凍切片病理檢查。結果 腫瘤切除后，距腫瘤3 mm處切取的標本冷凍切片發(fā)現(xiàn)上切緣累及者2例，下切緣累及者1例，健側聲帶前端累及者3例。距腫瘤5 mm處切取的標本均無癌殘留。兩組之間比較差異有顯著性(χ2=6.06，P<0.05)。隨訪5年生存率為76.7%。結論 在喉癌病人手術中，多點切取切緣快速冷凍切片病理檢查指導喉部分切除，可以保證在徹底切除腫瘤的基礎上最大程度地保留和重建病人喉的功能。手術切除范圍至少應以包括距腫瘤邊界5 mm以內的癌旁組織作為安全切緣的參考標準是較為適宜的。
【關鍵詞】 喉腫瘤;喉切除術;冷凍切片;切緣 THE SIGNIFICANCE OF PATHOLOGIC CHECK OF CUTTINGEDGE OF LARYNGOCARCINOMA UNDERGOING PARTIAL LARYNGECTOMY CHEN ZHIJUN, HUA HUI, HUANG YICHUAN, et al (Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China); [ABSTRACT] Objective To assess the significance of frozen section of incised margin of the cancer in partial laryngectomy (PL) for laryngocarcinoma. Methods Sixty patients with glottic laryngeal sqamous cell carcinoma (GLSCC) underwent PL between January 2000 and October 2003 at our department were reviewed. A vertical partial laryngectomy was performed and healthy side preserved in 40 cases, a laryngeal cleft and vocal cord and ventricular band were removal in 17 cases and frontolateral laryngectomy in three. A neck dissection was done in 11 cases. A total of 600 tissue samples in all of the 60 patients taken, away from3 mm and 5 mm of cancer margin, was sent for frozen section. Results Of the samples taken at 3 mm away from the cancer, two were involved by cancer at superior margin, one at inferior, and three at uninvolved vocal cord; of those taken at 5 mm away, no residual cancer was found, the difference being significant between the two groups (χ2=6.06,P<0.05). The 5year survival was 76.7%. Conclusion A frozen section of samples taken from multiple points of cancer guiding partial laryngectomy for cancer of larynx may guarantee maximum preservation of its function in radiacal resection of this malignacy. The scope of resection should at least include 5 mm of paraneoplastic tissue. [KEY WORDS] Tumor of larynx; Laryngectomy; Frozen section; Incised margin 醫(yī)學全.在線gydjdsj.org.cn
目前，手術切除仍然是治療喉癌最基本的手段，而手術切緣的安全性直接關系到喉癌病人術后的生存率，因此，對手術切緣的研究越來越受到重視，但僅憑手術者的經(jīng)驗和肉眼觀察來確定手術切除范圍，缺乏科學依據(jù)和嚴謹性。免疫組化方法操作復雜且周期長，尚無法用于臨床快速檢查。為了更準確地選擇喉癌手術切除的范圍，本研究在術中多點切取切緣喉組織行快速冷凍切片病理檢查，以進一步確定手術切除的范圍。 現(xiàn)將結果報告如下。
