下咽頭癌根治術におけるヨード散布の有用性 THE APPLICATION OF IODINE SOLUTION FOR LARYNGO-PHARYNGECTOMY

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下咽頭癌の手術の際に切除範囲を決定することを目的としたヨード散布の有用性を調べた。1997年より2006年までの10年間に当科に入院した下咽頭癌は82例あり,このうち初回治療で咽喉食摘を受けた患者43例を今回の解析対象とした。術中粘膜切除断端を決定する際,迅速組織診断に加え2001年よりヨードを散布し不染帯を切除範囲に含めることとしてきた。<BR>術後断端再発は,迅速組織診断へ提出しなかった11例中に1例あり,提出した32例中には存在しなかった。迅速組織診断へ提出した32例のうちヨードを散布したのは23例で,術中肉眼的には腫瘍浸潤を認めなくても迅速病理で断端腫瘍を認め追加切除した例は,ルゴール散布しなかった9例中4例,散布した23例中2例で両群間に有意差を認めた(p=0.03)。スキップした不染帯の組織は癌浸潤1例,上皮内癌1例,異型性1例,肉芽1例であった。<BR>下咽頭切除時のヨード散布は病変の存在が明示され安全域を的確に設定することができる。

The application of iodine solution to the epithelium of the hypopharynx before cutting the surgical margin off was studied to determine its feasibility as an aid to resection.<BR>From 1997 to 2006, 82 cases of hypopharynx carcinoma were treated at Fukushima Medical University Hospital, of which 43 cases underwent laryngo-pharyngectomy. These 43 cases were selected for the present study. In 32 of these cases, marginal sections were diagnosed pathologically during operation by frozen-section. In 23 of the 32 cases, iodine stained samples were examined, and the unstained area was restricted to the area of resection. In the other 11 cases, the margin of resection was determined by gross view.<BR>One case developed marginal recurrence, whose margin of resection was determined by visual examination. There were no cases of marginal recurrence, whose margin of resection was determined in frozen-section pathologically.<BR>In 32 cases, margins of resection were diagnosed by frozen-section, although further excision was added until the margin became negative. A significant difference in the incidence of positive margin at the first resection was observed between the cases with iodine staining (2 of 23 cases) and those without iodine staining (4 of 9 cases). In 23 cases with iodine staining, four cases were skipped to unstained areas and these pathological diagnoses were as follows; invasive carcinoma, carcinoma-in-situ, dysplasia, and granulation.<BR>Iodine staining for laryngo-pharyngectomy showed hidden malignant lesions and aids accurate resection of hypopharyngeal carcinoma.

収録刊行物

  • 頭頸部癌/ 日本頭頸部癌学会  

    頭頸部癌/ 日本頭頸部癌学会 32(4), 481-485, 2006-12-25 

    Japan Society for Head and Neck Cancer

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各種コード

  • NII論文ID(NAID)
    10018452807
  • NII書誌ID(NCID)
    AA11985555
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    13495747
  • データ提供元
    CJP書誌  J-STAGE 
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