应用Lugols碘和冷冻切片法评估口腔鳞癌术中手术缘的新技术

P. K., Amarnath P. Upasi, Sunil S. Byadgi, K. Rai
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摘要

手术被认为是治疗头颈部恶性肿瘤的主要方式,手术切除的最终目的是获得无肿瘤边缘。在执业外科医生中,没有统一的标准来定义明确的手术切缘。本研究拟结合口腔鳞状细胞癌(OSCC)冰冻切片法,探讨术中Lugol碘液标记手术切缘的充分性。术中Lugol 's碘染色及手术床缘冰冻切片分析前、上、下缘均为阴性,除1例(4.3%)后缘肿瘤阳性(未染色)。肿瘤切除后Lugol染色边缘卡方值与冷冻切片分析阴性结果差异有统计学意义,P值<0.001。因此,我们得出结论,Lugol碘有助于术中获得清晰的手术边界,可以避免外科医生之间对安全边界的偏见/判断错误,特别是在冷冻切片不可行的情况下。
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A Novel Technique for Intraoperative Assessment of Surgical Margin Using Lugols Iodine and Frozen Section Methods in Oral Squamous Cell Carcinoma
Surgery is considered to be the primary mode of treatment of head and neck malignancies and the ultimate aim of surgical resection is to obtain a tumor-free margin. No uniform criteria to define a clear surgical margin exist among practicing surgeons. This study intends to find the adequacy of surgical margin marking intraoperatively by Lugol’s iodine solution considering the frozen section method for oral squamous cell carcinoma (OSCC). Intraoperative staining with Lugol’s iodine and Frozen section analysis of margins of the surgical bed was negative in anterior, superior, and inferior specimens in all the cases, except in one case (4.3%), a posterior margin was found to be positive (unstained) for tumor. The chi-square value of the Lugol’s stained margins following resection of the tumor and negative results of frozen section analysis of the same was found to be statistically significant with the P value <0.001. Hence, we conclude that Lugol’s iodine helps in obtaining a clear surgical margin intra-operatively where inter-surgeons bias/judgment errors regarding safe margin can be avoided, especially in cases where the frozen section is not feasible.
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