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头颈外科论文喉癌喉部分切除术中切缘病理检查的意义
【摘要】目的 探讨喉癌喉部分切除术中切缘冷冻切片病理检查的临床意义。方法 以我院2000年1月～2003年10月间60例喉部分切除的喉癌声门型病人为观察对象;全部病例术前病理诊断为鳞状细胞癌。行喉裂开患侧声带、室带切除17例，行垂直半喉切除40例，行垂直半喉加额侧切除3例，同期行颈淋巴结清扫11例。术中在距肿瘤边缘3、5 mm切缘处分别选多点切取组织600份标本行快速冷冻切片病理检查。结果 肿瘤切除后，距肿瘤3 mm处切取的标本冷冻切片发现上切缘累及者2例，下切缘累及者1例，健侧声带前端累及者3例。距肿瘤5 mm处切取的标本均无癌残留。两组之间比较差异有显著性(χ2=6.06，P<0.05)。随访5年生存率为76.7%。结论 在喉癌病人手术中，多点切取切缘快速冷冻切片病理检查指导喉部分切除，可以保证在彻底切除肿瘤的基础上最大程度地保留和重建病人喉的功能。手术切除范围至少应以包括距肿瘤边界5 mm以内的癌旁组织作为安全切缘的参考标准是较为适宜的。
【关键词】 喉肿瘤;喉切除术;冷冻切片;切缘 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 医学全.在线www.med126.com
目前，手术切除仍然是治疗喉癌最基本的手段，而手术切缘的安全性直接关系到喉癌病人术后的生存率，因此，对手术切缘的研究越来越受到重视，但仅凭手术者的经验和肉眼观察来确定手术切除范围，缺乏科学依据和严谨性。免疫组化方法操作复杂且周期长，尚无法用于临床快速检查。为了更准确地选择喉癌手术切除的范围，本研究在术中多点切取切缘喉组织行快速冷冻切片病理检查，以进一步确定手术切除的范围。 现将结果报告如下。
