声门上型喉癌颈淋巴隐匿性转移及其处理  

Pathological feature and management of occult lymphatic metastasis in supraglottic carcinoma

作　　者：贾深汕[1] 王艳颖[2] 裴荣[1] 孙冀[1] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院头颈外科,150040 [2]哈尔滨医科大学附属肿瘤医院病理科,150040

出　　处：《中华耳鼻咽喉头颈外科杂志》2005年第2期103-105,共3页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：黑龙江省政府"九五"攻关基金资助项目(GOOC190502)

摘　　要：目的探讨声门上型喉癌颈淋巴隐匿性转移规律及其处理方法.方法选择术前未行放疗、化疗的声门上喉鳞状细胞癌,临床N0M0病例,共30例,男19例,女11例;年龄40～72岁,平均54.8岁;按UICC(1997年)标准分期T2 8例,T3 18例,T4 4例.行主病变侧肩胛舌骨肌上颈清扫术(supraomohyoid neck dissecton,SOHND),将获得淋巴结逐一行病理组织学检查,观察其转移规律及临床治疗效果.结果首次颈清扫术30例中有6例颈淋巴结转移癌阳性,在2～3年随访中有3例发生对侧颈淋巴结转移,计有9例颈淋巴转移,隐匿性转移率同侧为20%(6/30),对侧为10%(3/30).颈清扫术共获淋巴结527个,平均每侧17.6个.获转移阳性淋巴结10个,其中Ⅱ区9个,Ⅲ区1个,Ⅰ区无癌转移.喉及主病变侧颈部均无复发,2年无瘤生存率86.7%(26/30).结论声门上型喉癌颈淋巴结隐匿性转移率达30%,采用Ⅱ、Ⅲ区的择区性颈清扫术处理其颈淋巴结(Ⅰ区可不必作为常规清扫区域)是切实可行的.Objective To study the pathologic feature and management methods of occult lymphatic metastasis in patients with supraglottic carcinoma. Methods The following are criteria of patients selection:① Supraglottic squamous cell carcinoma;② Clinical N0M0;③no preoperative radiotherapy and(or) chemotherapy. Thirty patients were recruited, male 19 cases, female 11;age:40~72yr, average 54.8yr; T2 8 cases,T3 18,T4 4(by UICC 1997). Ipsilateral supraomohyoid neck dissections were perfomed in all cases. Lymph nodes were studied histologically according to the levels of dissection.Results Six of 30 cases were positive nodes histologically in first operation, 3 were occurrenced neck metastasis in opposite side during follow ups. Occult metastasis rate was 20% (6/30) ipsilaterdly and 10% contralaterally. 527 lymph nodes were collected in all of 30 patients, average 17.6 nodes in every side neck. Ten positive lymph nodes histologically were harvested. The distribution of metastatic lymph nodes was 9 in level Ⅱ, 1 in level Ⅲ, no in level Ⅰ. N0 recurrence in larynx and (or) at the neck after dissection. Two years survival rates was 86.7%(26/30) without tumor.Conclusion Occult metastasis rate of supraglottic carcinoma is as high as 30%. The selective lateral neck dissection of level Ⅱ、Ⅲ and occasionally, level Ⅳ was recommanded.

关 键 词：声门上型喉癌 颈淋巴 肿瘤转移 择区性颈清扫术 

分 类 号：R739.65[医药卫生—肿瘤]