择区性颈清扫术在头颈部鳞状细胞癌颈淋巴转移患者中应用的初步分析  

Selective neck dissection for node-positive necks （N1, N2） in patients with head and neck squamous cell carcinoma

作　　者：陶冶[1] 刘业海[1] 余崇仙[1] 李红武[1] 臧燕[1] 

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉科,合肥230022

出　　处：《中华耳鼻咽喉头颈外科杂志》2008年第9期681-685,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：安徽省卫生厅临床医学重点学科应用技术计划项目（05A007）

摘　　要：目的探讨择区性颈清扫术（selectiveneckdissection）在伴N1、N2期颈淋巴转移兴颈部鳞状细胞癌（简称鳞癌）中的疗效。方法回顾性分析36例伴N1、N2期颈淋巴转移的头颈部鳞癌患者行40侧择区性颈清扫术，16侧行全颈清扫术的临床资料，评价择区性颈清扫术的疗效。Kaplan—Meier法行累积生存率统计，Log-rank检验比较生存率差异；有无淋巴结包膜外侵犯病例复发率的差异分析采用Fisher精确概率法；采用Cox比例风险模型对可能影响患者生存时间的因素进行分析。结果36例患者3和5年生存率分别为76．8％和54．3％。N1＋N2a组3和5年生存率均为100％，N2b＋N2c组3和5年生存率分别为59．4％和32．0％，Log—rank检验两组患者5年生存率差异有统计学意义（P=0．003）。有无淋巴结包膜外侵犯分组的复发率分别为36．4％和3．4％，差异有统计学意义（P=0．015）；3年生存率分别为45．5％和81．8％，5年生存率分别为39．7％和65．5％，差异均有统计学意义（P值分别为0．0148和0．0423）。多因素分析证实淋巴结包膜外侵犯是影响患者生存时间的危险因素（P=0．042，OR=0．328，OR值95％可信限为0．112～0．959）。结论头颈部鳞癌N1期患者采用择区性颈清扫术可有满意的疗效，对N2期病变和伴有淋巴结包膜外侵犯的病例需谨慎处理，必要时扩大清扫范围甚至变更术式为全颈清扫术或改良全颈清扫术以提高术后颈部肿瘤控制率。Objective To evaluate therapeutic effect in a consecutive series of patients with nodepositive of N1 and N2 head and neck squamous cell carcinoma （ HNSCC ） who underwent selective neck dissection as part of their treatment in a single institution. Methods Retrospectively analyzed 36 patients with node positive head and neck squamous cell carcinoma, which had undergone 40 selective neck dissection（SND） and 16 radical neck dissections（RND） and the therapeutic effects of the SND in HNSCC patients with node positive. Kaplan-Meier method was used to estimate the survival analysis among the different levels, and log-rank method for comparison of the different distribution of the several influential factors of the survival; the fisher＇s exact test was used to test the difference of the neck recurrence between the groups that with or without lymph node extracapsular spread. Cox proportional hazard model was applied to screen the potentially significant prognostic factors. Results The 3 and 5 years survival rate of this group were 76. 8% and 54. 3% retrospectively. The 3 and 5 years＇ survival rate were both 100% in the N1 ＋ N2a group, while 59.4% and 32. 0% in the N2b ＋ N2c group correspondingly. With log-rank test between the two groups above, significant statistical difference was revealed （P =0. 003 ） in the 5 years＇ survival rates. To the groups that with or without extracapsular spread（ECS） , the recurrence rate were 36.4% and 3.4% respectively and significant statistical difference existed （ P = 0. 015 ）. In the groups that with or without ECS, the 3 years＇ survival rate were 45.5% and 81.8% , and 5 years＇ survival rate were 39. 7% and 65.5% respectively, also the significant statistical difference （ P = 0. 0148 and P = 0. 0423 respectively） had presented. Conclusions SND is appropriate for treatment of N1 neck of the patient with HNSCC; However, SND should be taken very cautious to the N2 neck and node-positive neck with extracapsular spread, MRND or RND might be a better c

关 键 词：颈淋巴结清扫术 头颈部肿瘤 癌 鳞状细胞 肿瘤复发 局部 淋巴转移 

分 类 号：R686[医药卫生—骨科学]