中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2008年
9期
681-685
,共5页
陶冶%刘业海%余崇仙%李红武%臧燕
陶冶%劉業海%餘崇仙%李紅武%臧燕
도야%류업해%여숭선%리홍무%장연
颈淋巴结清扫术%头颈部肿瘤%癌,鳞状细胞%肿瘤复发,局部%淋巴转移
頸淋巴結清掃術%頭頸部腫瘤%癌,鱗狀細胞%腫瘤複髮,跼部%淋巴轉移
경림파결청소술%두경부종류%암,린상세포%종류복발,국부%림파전이
Radical neck dissection%Head and neck neoplasms%Carcinoma,Squamous cell%Neoplasm recurrence,local%Lymphatic metastasis
目的 探讨择区性颈清扫术(selective neck dissection)在伴N1、N2期颈淋巴转移头颈部鳞状细胞癌(简称鳞癌)中的疗效.方法 回顾性分析36例伴N1、N2期颈淋巴转移的头颈部鳞癌患者行40侧择区性颈清扫术,16侧行全颈清扫术的临床资料,评价择区性颈清扫术的疗效.KaplanMeier法行累积生存率统计,Log-rank检验比较生存率差异;有无淋巴结包膜外侵犯病例复发率的差异分析采用Fisher精确概率法;采用Cox比例风险模型对可能影响患者生存时间的因素进行分析.结果 36例患者3和5年生存率分别为76.8%和54.3%.N1+N2a组3和5年生存率均为100%,N2b+N2c组3和5年生存率分别为59.4%和32.0%,Log-rank检验两组患者5年生存率差异有统计学意义(P=0.003).有无淋巴结包膜外侵犯分组的复发率分别为36.4%和3.4%,差异有统计学意义(P=0.015);3年生存率分别为45.5%和81.8%,5年生存率分别为39.7%和65.5%,差异均有统计学意义(P值分别为0.0148和0.0423).多因素分析证实淋巴结包膜外侵犯是影响患者生存时间的危险因素(P=0.042,OR=0.328,OR值95%可信限为0.112～0.959).结论 头颈部鳞癌N1期患者采用择区性颈清扫术可有满意的疗效,对N2期病变和伴有淋巴结包膜外侵犯的病例需谨慎处理,必要时扩大清扫范围甚至变更术式为全颈清扫术或改良全颈清扫术以提高术后颈部肿瘤控制率.
目的 探討擇區性頸清掃術(selective neck dissection)在伴N1、N2期頸淋巴轉移頭頸部鱗狀細胞癌(簡稱鱗癌)中的療效.方法 迴顧性分析36例伴N1、N2期頸淋巴轉移的頭頸部鱗癌患者行40側擇區性頸清掃術,16側行全頸清掃術的臨床資料,評價擇區性頸清掃術的療效.KaplanMeier法行纍積生存率統計,Log-rank檢驗比較生存率差異;有無淋巴結包膜外侵犯病例複髮率的差異分析採用Fisher精確概率法;採用Cox比例風險模型對可能影響患者生存時間的因素進行分析.結果 36例患者3和5年生存率分彆為76.8%和54.3%.N1+N2a組3和5年生存率均為100%,N2b+N2c組3和5年生存率分彆為59.4%和32.0%,Log-rank檢驗兩組患者5年生存率差異有統計學意義(P=0.003).有無淋巴結包膜外侵犯分組的複髮率分彆為36.4%和3.4%,差異有統計學意義(P=0.015);3年生存率分彆為45.5%和81.8%,5年生存率分彆為39.7%和65.5%,差異均有統計學意義(P值分彆為0.0148和0.0423).多因素分析證實淋巴結包膜外侵犯是影響患者生存時間的危險因素(P=0.042,OR=0.328,OR值95%可信限為0.112～0.959).結論 頭頸部鱗癌N1期患者採用擇區性頸清掃術可有滿意的療效,對N2期病變和伴有淋巴結包膜外侵犯的病例需謹慎處理,必要時擴大清掃範圍甚至變更術式為全頸清掃術或改良全頸清掃術以提高術後頸部腫瘤控製率.
목적 탐토택구성경청소술(selective neck dissection)재반N1、N2기경림파전이두경부린상세포암(간칭린암)중적료효.방법 회고성분석36례반N1、N2기경림파전이적두경부린암환자행40측택구성경청소술,16측행전경청소술적림상자료,평개택구성경청소술적료효.KaplanMeier법행루적생존솔통계,Log-rank검험비교생존솔차이;유무림파결포막외침범병례복발솔적차이분석채용Fisher정학개솔법;채용Cox비례풍험모형대가능영향환자생존시간적인소진행분석.결과 36례환자3화5년생존솔분별위76.8%화54.3%.N1+N2a조3화5년생존솔균위100%,N2b+N2c조3화5년생존솔분별위59.4%화32.0%,Log-rank검험량조환자5년생존솔차이유통계학의의(P=0.003).유무림파결포막외침범분조적복발솔분별위36.4%화3.4%,차이유통계학의의(P=0.015);3년생존솔분별위45.5%화81.8%,5년생존솔분별위39.7%화65.5%,차이균유통계학의의(P치분별위0.0148화0.0423).다인소분석증실림파결포막외침범시영향환자생존시간적위험인소(P=0.042,OR=0.328,OR치95%가신한위0.112～0.959).결론 두경부린암N1기환자채용택구성경청소술가유만의적료효,대N2기병변화반유림파결포막외침범적병례수근신처리,필요시확대청소범위심지변경술식위전경청소술혹개량전경청소술이제고술후경부종류공제솔.
Objective To evaluate therapeutic effect in a consecutive series of patients with nodepositive of N1 and N2 head and neck squgnlous cell carcinoma (HNSCC)who underwent selective neck dissection as part of their treatment in a single institution.Methods Retrospectively analyzed 36 patients with node positive head and neck squamous cell carcinoma,which had undergone 40 selective neck dissection (SND) and 16 radical neck dissections (RND) and the therapeutic effects of the SND in HNSCC patients with node positive.Kaplan-Meier method was used to estimate the survival analysis among the different levels,and log-rank method for eomparison of the different distribution of the several irdluential factors of the survival;the fisher's exact test was used to test the difference of the neck recurrence betwecn the groups that with or without lymph node extracapsular spread.Cox proportional hazard model wag applied to screen the potentially significant prognostic factors.Results The 3 and 5 years survival rate of this group were 76.8% and 54.3% retrospectively.The 3 and 5 years'survival rate were both 100% in the N1+N2a group,while 59.4% and 32.0% in the N2b+N2c group correspondingly.With log-rank test between the two groups above,significant statistical difference wag revealed (P=0.003) in the 5 years'survival rates.To the groups that with or without extracapsular spread(ECS),the recurrence rate were 36.4% and 3.4% respectively and significant statistical difference existed(P=0.015).In the groups that with or without ECS,the 3 years'survival rate were 45.5% and 81.8%,and 5 years'survival rate were 39.7% and 65.5% respectively,also the significant smtistical difference (P=0.0148 and P=0.0423 respectively) had presented.Conclusions SND is appropriate for treatment of N1 neck of the patient with HNSCC:However,SND should be taken very cautious to the N2 neck and node-positive neck with extracapsular spread,MRND or RND might be a better choice to prevent the recurrence in the neck.
