鼻咽癌放疗后颈淋巴结复发和残留的外科治疗  

Surgery for the recurrent and persistent lymph node of nasopharyngeal carcinoma after radiotherapy

作　　者：夏良平[1] 曾宗渊[2] 陈直华[2] 郭朱明[1] 郭翔[3] 张诠[2] 

机构地区：[1]中山大学肿瘤防治中心综合三科,广州510060 [2]中山大学肿瘤防治中心头颈科,广州510060 [3]中山大学肿瘤防治中心鼻咽科,广州510060

出　　处：《中华耳鼻咽喉头颈外科杂志》2005年第2期95-99,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析鼻咽癌放疗后颈淋巴结残留和复发者的4种清扫方式的疗效,希望能为临床提供更多手术方式的选择。方法回顾性分析88例鼻咽癌患者资料,分析总体疗效生存率、复发率、远处转移率和手术并发症;比较全颈清扫、改良性、择区性颈清扫术和颈淋巴结切除术4种手术方式的生存率、复发率;比较术后颈部放疗与否者的生存率、复发率。结果采用生命表法统计88例鼻咽癌患者5年累积生存率428%,颈淋巴结复发率为227%。Ⅱ期、Ⅲ期、Ⅳ期患者的5年生存率(生命表法)分别为567%、361%、324%。全颈清扫术、改良性颈清扫术、择区性颈清扫术和颈淋巴结切除术组5年累积生存率(KaplanMeier法)分别为398%、600%、379%和441%,差异无统计学意义(LogRank统计值=10,P=08011),颈淋巴结复发率差异也无统计学意义(χ2=0470,P=0493)。颈清扫术后颈部给予与未给予术后放疗者的5年累积生存率(KaplanMeier法)分别为391%和453%,差异无统计学意义(LogRank统计值=006,P=08138),颈淋巴结复发率差异也无统计学意义(χ2=0593,P=0441)。结论只要合理选择病例,配合必要的术后局部和浅表的放疗,4种清扫方式都能有效和安全地控制肿瘤。Objectives To investigate the effect of four types of neck dissections for the recurrent and persistent lymph nodes of NPC after radiotherapy. Methods The clinical data of 88 cases of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively, the 5-year survival rate, recurrent rate, distant metastastic rate and surgical complications were analyzed. The survival rate and recurrent rate of the radical neck dissection (RND), modified radical neck dissection (MRND), selective neck dissection (SND) and lymph node resection (LNR) were compared. The survival and recurrent rate between those with and without postoperative radiotherapy were investigated as well. Results The 5-year survival rate and recurrent rate of whole group were 42.8%and 22.7%, respectively. As for the patients with disease staged Ⅱ, Ⅲ, Ⅳ, the 5-year survival rates were 56.7%, 36.1% and 32.4%, respectively. The 5-year survival rate of groups of RND, MRND, SND and LMR were 39.8%, 60.0%, 37.9% and 44.1%, respectively, the differences were insignificant (Log Rank =1.0,P=0.8011), the recurrent rate of the lymph node among the 4 groups were insignificant either (χ2=0.470, P=0.493). The 5-year survival rates of those with and without postoperative radiotherapy were 39.1% and 45.3%, respectively, the differences were insignificant (Log Rank =0.06, P=0.8138), the recurrent rate of the two groups were insignificant (χ2=0.593, P=0.441). Conclusions ~The four types of neck dissection were effective and safe to control the recurrent and persistent lymph nodes in the neck after radiotherapy, as long as choosing patients rationally and gave postoperative radiotherapy if necessary.

关 键 词：鼻咽癌 放射治疗 颈淋巴结 复发 肿瘤残留 清扫方式 颈淋巴结清扫术 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]