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
2014年
7期
553-557
,共5页
徐伟%吕正华%邹纪东%冯守昊%曹洪源
徐偉%呂正華%鄒紀東%馮守昊%曹洪源
서위%려정화%추기동%풍수호%조홍원
下咽肿瘤%癌,鳞状细胞%淋巴转移%体层摄影术,X线计算机%颈淋巴结清扫术
下嚥腫瘤%癌,鱗狀細胞%淋巴轉移%體層攝影術,X線計算機%頸淋巴結清掃術
하인종류%암,린상세포%림파전이%체층섭영술,X선계산궤%경림파결청소술
Hypopharyngeal neoplasms%Carcinoma,squamous cell%Lymphatic metastasis%Tomography,X-ray computed%Radical neck dissection
目的 探讨咽后淋巴清扫术在晚期下咽鳞状细胞癌治疗中的必要性及适应证.方法 2011年2月至2012年12月我院收治的54例晚期下咽癌患者,其中梨状窝癌45例,下咽后壁癌5例,环后癌4例.采用手术切除+术后辅助放射治疗,所有患者均行双侧颈淋巴清扫+咽后淋巴清扫术.术前均行强化CT扫描检查评估咽后淋巴结状态,并与咽后淋巴清扫术后病理结果进行对照分析.结果 术前CT检查考虑咽后淋巴结转移13例,无转移41例.术后病理证实存在咽后淋巴结转移者12例(22.2％),8例为梨状窝癌,4例为下咽后壁癌,其中CT发现转移7例,未发现转移5例.术前CT诊断咽后淋巴结转移总的准确率为79.6％,敏感性为58.3％,特异性为85.7％.12例患者均有颈部淋巴结转移,其中N2-3者11例(91.7％),其中N2c者6例(50.0％).所有患者均随访1年以上,未发现咽后淋巴结复发转移者.结论 晚期下咽癌发生咽后淋巴结转移并不少见,术前CT检查对评估早期咽后淋巴结转移的效果有限.建议对下咽后壁癌、T3-T4的梨状窝癌及颈部N2以上的病例,常规行咽后淋巴结探查与清扫术.
目的 探討嚥後淋巴清掃術在晚期下嚥鱗狀細胞癌治療中的必要性及適應證.方法 2011年2月至2012年12月我院收治的54例晚期下嚥癌患者,其中梨狀窩癌45例,下嚥後壁癌5例,環後癌4例.採用手術切除+術後輔助放射治療,所有患者均行雙側頸淋巴清掃+嚥後淋巴清掃術.術前均行彊化CT掃描檢查評估嚥後淋巴結狀態,併與嚥後淋巴清掃術後病理結果進行對照分析.結果 術前CT檢查攷慮嚥後淋巴結轉移13例,無轉移41例.術後病理證實存在嚥後淋巴結轉移者12例(22.2％),8例為梨狀窩癌,4例為下嚥後壁癌,其中CT髮現轉移7例,未髮現轉移5例.術前CT診斷嚥後淋巴結轉移總的準確率為79.6％,敏感性為58.3％,特異性為85.7％.12例患者均有頸部淋巴結轉移,其中N2-3者11例(91.7％),其中N2c者6例(50.0％).所有患者均隨訪1年以上,未髮現嚥後淋巴結複髮轉移者.結論 晚期下嚥癌髮生嚥後淋巴結轉移併不少見,術前CT檢查對評估早期嚥後淋巴結轉移的效果有限.建議對下嚥後壁癌、T3-T4的梨狀窩癌及頸部N2以上的病例,常規行嚥後淋巴結探查與清掃術.
목적 탐토인후림파청소술재만기하인린상세포암치료중적필요성급괄응증.방법 2011년2월지2012년12월아원수치적54례만기하인암환자,기중리상와암45례,하인후벽암5례,배후암4례.채용수술절제+술후보조방사치료,소유환자균행쌍측경림파청소+인후림파청소술.술전균행강화CT소묘검사평고인후림파결상태,병여인후림파청소술후병리결과진행대조분석.결과 술전CT검사고필인후림파결전이13례,무전이41례.술후병리증실존재인후림파결전이자12례(22.2％),8례위리상와암,4례위하인후벽암,기중CT발현전이7례,미발현전이5례.술전CT진단인후림파결전이총적준학솔위79.6％,민감성위58.3％,특이성위85.7％.12례환자균유경부림파결전이,기중N2-3자11례(91.7％),기중N2c자6례(50.0％).소유환자균수방1년이상,미발현인후림파결복발전이자.결론 만기하인암발생인후림파결전이병불소견,술전CT검사대평고조기인후림파결전이적효과유한.건의대하인후벽암、T3-T4적리상와암급경부N2이상적병례,상규행인후림파결탐사여청소술.
Objective To investigate the necessity and feasibility of planned dissection of the retropharyngeal lymph nodes (RPLN) in advanced hypopharyngeal cancer.Methods Between February 2011 and December 2012,54 patients with advanced hypopharyngeal cancer accepted planned dissection of the RPLN during primary surgery.There were 45 cases of pyriform sinus carcinoma,5 cases of posterior pharyngeal wall carcinoma,and 4 cases of postcricoid carcinoma.All patients underwent surgery and postoperative adjuvant radiotherapy,meanwhile bilateral neck dissection and RPLN dissection were performed.All patients received preoperative CT scanning (with contrast).The results of the radiographic assessment were compared with the postoperative pathologic findings respectively.Results RPLN were confirmed positive by pathology in 13 cases,and negative in another 43 cases.For the entire treatment group,metastasis to the RPLN was confirmed hispathologically in 12 patients (22.2％).Eight patients were pyriform sinus carcinoma,4 were posterior pharyngeal wall carcinoma.Among them,seven patients were diagnosed as RPLN metastasis by CT imaging and another 5 patients were not confirmed.The overall accuracy for the radiologist's interpretation was 79.6％,the sensitivity was 58.3％,and the specificity was found to be 85.7％.Eleven patients were N2-3 and 6 patients were N2c.No RPLN metastasis or recurrence was found during more than one year follow-up period.Conclusions It is not rare for the RPLN metastasis in patients with advanced hypopharyngeal carcinoma.CT imaging is not effective in determining the early presence of RPLN metastasis.The planned dissection of the RPLN is highly recommended during the initial surgery of hypopharyngeal cancer,especially in posterior pharyngeal wall carcinoma,T3-4 pyriform sinus carcinoma and staged N2-3 cases.
