CAJ | 학술논문

目的探讨鼻咽癌放疗后颈部淋巴结复发或残留患者的手术方式和预后影响因素.方法回顾性分析2001年1月至2011年12月因鼻咽癌放疗后颈部淋巴结复发或残留行手术治疗的153例患者的临床资料.复发分期rN1 109例,rN2 17例,rN3 27例.其中17例为双侧,共170侧颈部手术,其中66侧行改良性颈淋巴清扫术,28侧行择区性颈淋巴清扫术,9侧行局部切除术,3侧行腮腺切除术,48侧行根治性颈淋巴清扫术,16侧行扩大根治性颈淋巴清扫术.使用SPSS 16.0统计软件包建立数据库,组间差异采用x2检验.生存分析采用Kaplan-Meier法,采用Log-rank检验进行单因素分析,采用Cox回归模型进行多因素分析.结果本组患者转移淋巴结Ⅰ区转移20例(13.1％),腮腺区转移7例(4.6％).全组3年和5年累积生存率分别为57.2％和40.6％,中位生存期49个月.Cox分析显示,复发分期(rN),淋巴结大小和患者年龄是影响预后的危险因素.结论鼻咽癌放疗后颈部挽救性手术治疗安全有效,可合理选择改良或择区性颈淋巴清扫术以改善功能.临床Ⅰ区和腮腺区淋巴结未见转移者可不做常规清扫,但需高度警惕.复发分期rN3或转移淋巴结长径＞6 cm,年龄＞50岁者预后差.
목적 탐토비인암방료후경부림파결복발혹잔류환자적수술방식화예후영향인소.방법 회고성분석2001년1월지2011년12월인비인암방료후경부림파결복발혹잔류행수술치료적153례환자적림상자료.복발분기rN1 109례,rN2 17례,rN3 27례.기중17례위쌍측,공170측경부수술,기중66측행개량성경림파청소술,28측행택구성경림파청소술,9측행국부절제술,3측행시선절제술,48측행근치성경림파청소술,16측행확대근치성경림파청소술.사용SPSS 16.0통계연건포건립수거고,조간차이채용x2검험.생존분석채용Kaplan-Meier법,채용Log-rank검험진행단인소분석,채용Cox회귀모형진행다인소분석.결과 본조환자전이림파결Ⅰ구전이20례(13.1％),시선구전이7례(4.6％).전조3년화5년루적생존솔분별위57.2％화40.6％,중위생존기49개월.Cox분석현시,복발분기(rN),림파결대소화환자년령시영향예후적위험인소.결론 비인암방료후경부만구성수술치료안전유효,가합리선택개량혹택구성경림파청소술이개선공능.림상Ⅰ구화시선구림파결미견전이자가불주상규청소,단수고도경척.복발분기rN3혹전이림파결장경＞6 cm,년령＞50세자예후차.
Objective To investigate the surgical procedures and prognosis for neck recurrence or residue of nasopharyngeal carcinoma(NPC) after primary radiotherapy.Methods A total of 153 cases with neck recurrence or residue after radiotherapy in NPC who received salvage neck surgery between January 2001 and December 2011 were retrospectively analyzed.There were rN1 109 cases,rN2 17 cases and rN3 27 cases.Of them 17 cases received bilateral neck dissection(ND) simultaneously.The surgical procedures included the modified radical neck dissection (MRND) in 66 cases,radical neck dissection (RND) in 48 cases,selective neck dissection (SND) in 28 cases,enlarged radical neck dissection (ERND) in 16 cases,local excision in 9 cases,and parotidectomy in 3 cases.The Kaplan-Meier method was used to calculate survival curves,and the differences between groups were calculated by x2 tests.Results There were 20 cases(13.1％)with lymph node(LN) metastasis in level Ⅰ and 7 cases (4.6％) with parotid gland LN metastasis.The 3-year and 5-year overall survival rates were 57.2％ and 40.6％ respectively,and the median survival time was 49 months.Cox regression analysis revealed that rN staging,size of LN and age were the main prognosis factors for survival.Conclusions Salvage surgery was effective for neck recurrence or residue of NPC after primary treatment,and MRND and SND are reasonable options so as to improve functionality.Dissection of LN in level Ⅰ and parotid gland should be selective.Patients with stage rN3 or LN ＞ 6 cm or age ＞ 50 years had poor prognosis.