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
2010年
9期
747-750
,共4页
贾深汕%王艳颖%何洪江%项丞
賈深汕%王豔穎%何洪江%項丞
가심산%왕염영%하홍강%항승
喉肿瘤%癌,鳞状细胞%肿瘤复发,局部%颈淋巴结清扫术
喉腫瘤%癌,鱗狀細胞%腫瘤複髮,跼部%頸淋巴結清掃術
후종류%암,린상세포%종류복발,국부%경림파결청소술
Laryngeal neoplasms%Carcinoma,squamous cell%Neoplasm recurrence%Neck dissection
目的 研究择区性即ⅡA、ⅡB和Ⅲ区颈淋巴结清扫术(selective neck dissection,SND)治疗临床颈淋巴结阴性(clinical node negative,cN0)的声门上荆喉鳞癌隐匿性颈转移的可行性.方法 回顾性分析2002年10月至2006年3月在哈尔滨医科大学肿瘤医院头颈外科行SND(ⅡA、ⅡB和Ⅲ区)治疗52例cN0声门上型喉癌的治疗结果.结果 52例cNO声门上型喉癌中32例同期行单侧(ⅡA、ⅡB和Ⅲ区),20例行双侧SND.52例颈清扫标本病理检查发现,颈转移阳性者15例(28.9%).3例首次病理检查阴性者在随访中发生未手术侧颈部转移,总的颈隐匿性转移率为34.6%(18/52),单侧、双侧隐匿性颈转移率分别为28.8%和5.8%.72侧颈清标本共获淋巴结1190枚,其中病理阳性30枚,分布于ⅡA区25枚(83.3%)、Ⅲ区5枚(16.7%).术侧颈部复发率为5.8%(3/52).Kaplan-Meier法统计3年累积生存率为84.6%.淋巴结病理阴性和阳性的颈部复发率分别为0(0/34)和16.7%(3/18),差异有统计学意义(Fisher精确检验,P=0.021),有无包膜外侵犯的颈部复发率分别为50%(2/4)和2.1%(1/48),差异有统计学意义(Fisher精确检验,户=0.002).结论 颈SND(ⅡA、ⅡB和Ⅲ区)治疗cNO声门上型喉癌颈隐匿性转移是可行的,该术式能缩短手术时间、减少并发症且不影响肿瘤治疗效果.
目的 研究擇區性即ⅡA、ⅡB和Ⅲ區頸淋巴結清掃術(selective neck dissection,SND)治療臨床頸淋巴結陰性(clinical node negative,cN0)的聲門上荊喉鱗癌隱匿性頸轉移的可行性.方法 迴顧性分析2002年10月至2006年3月在哈爾濱醫科大學腫瘤醫院頭頸外科行SND(ⅡA、ⅡB和Ⅲ區)治療52例cN0聲門上型喉癌的治療結果.結果 52例cNO聲門上型喉癌中32例同期行單側(ⅡA、ⅡB和Ⅲ區),20例行雙側SND.52例頸清掃標本病理檢查髮現,頸轉移暘性者15例(28.9%).3例首次病理檢查陰性者在隨訪中髮生未手術側頸部轉移,總的頸隱匿性轉移率為34.6%(18/52),單側、雙側隱匿性頸轉移率分彆為28.8%和5.8%.72側頸清標本共穫淋巴結1190枚,其中病理暘性30枚,分佈于ⅡA區25枚(83.3%)、Ⅲ區5枚(16.7%).術側頸部複髮率為5.8%(3/52).Kaplan-Meier法統計3年纍積生存率為84.6%.淋巴結病理陰性和暘性的頸部複髮率分彆為0(0/34)和16.7%(3/18),差異有統計學意義(Fisher精確檢驗,P=0.021),有無包膜外侵犯的頸部複髮率分彆為50%(2/4)和2.1%(1/48),差異有統計學意義(Fisher精確檢驗,戶=0.002).結論 頸SND(ⅡA、ⅡB和Ⅲ區)治療cNO聲門上型喉癌頸隱匿性轉移是可行的,該術式能縮短手術時間、減少併髮癥且不影響腫瘤治療效果.
목적 연구택구성즉ⅡA、ⅡB화Ⅲ구경림파결청소술(selective neck dissection,SND)치료림상경림파결음성(clinical node negative,cN0)적성문상형후린암은닉성경전이적가행성.방법 회고성분석2002년10월지2006년3월재합이빈의과대학종류의원두경외과행SND(ⅡA、ⅡB화Ⅲ구)치료52례cN0성문상형후암적치료결과.결과 52례cNO성문상형후암중32례동기행단측(ⅡA、ⅡB화Ⅲ구),20례행쌍측SND.52례경청소표본병리검사발현,경전이양성자15례(28.9%).3례수차병리검사음성자재수방중발생미수술측경부전이,총적경은닉성전이솔위34.6%(18/52),단측、쌍측은닉성경전이솔분별위28.8%화5.8%.72측경청표본공획림파결1190매,기중병리양성30매,분포우ⅡA구25매(83.3%)、Ⅲ구5매(16.7%).술측경부복발솔위5.8%(3/52).Kaplan-Meier법통계3년루적생존솔위84.6%.림파결병리음성화양성적경부복발솔분별위0(0/34)화16.7%(3/18),차이유통계학의의(Fisher정학검험,P=0.021),유무포막외침범적경부복발솔분별위50%(2/4)화2.1%(1/48),차이유통계학의의(Fisher정학검험,호=0.002).결론 경SND(ⅡA、ⅡB화Ⅲ구)치료cNO성문상형후암경은닉성전이시가행적,해술식능축단수술시간、감소병발증차불영향종류치료효과.
Objective To evaluate the feasibility of routine inclusion of levels Ⅱ and Ⅲ in neck dissection to treat the occult neck metastasis as elective treatment for supraglottic cancer with clinically node negative (cN0). Methods The results of 52 cN0 patients with supraglottic cancer treated in Tumor Hospital, Harbin Medical University from October 2002 to March 2006 were reviewed retrospectivelly.Results Of the 52 patients with supraglottic cancer and cN0 neck, 32 cases received ipsilateral SND (levels Ⅱ and Ⅲ ) and 20 cases with bilateral SND ( levels Ⅱ and Ⅲ ). Fifteen (28. 9% ) of 52 patients were found to have occult regional metastasis on pathological examination. Three patients without metastasis in dissected side at pathologic examination showed metastasis in the contralateral undissected neck later on therefore the total occult metastasis rate was 34. 6% (18 of 52). The unilateral and bilateral neck occult metastases were determined in 15 cases (28. 9% ) and 3 cases (5.8%) respectively. A total of 1190 lymph nodes were harvested in 72 specimens, with 30 positive nodes. The distributions of the 30 positive nodes were as follows: level Ⅱ A 83. 3% (25 nodes), level Ⅲ 16. 7% (5 nodes). Three-year regional recurrence rate was 5.8%. The 3-year survival rate was 84. 6% according to Kaplan-Meier in all cN0 patients ( n =52). Patients with positive neck metastasis and patients with extracapsular spread had higher regional recurrence rates ( P= 0.021 and 0. 002, respectively ). Conclusions The results support the use of SND(levels Ⅱ and Ⅲ ) in cN0 supraglottic cancer. This procedure will reduce both operating time and morbidity, without compromising the oncologic result.
