喉癌颈淋巴结转移行颈清扫术后的疗效观察  

Effect of neck dissection after laryngectomy in laryngeal carcinoma patients with lymphatic metastasis

作　　者：梁建民[1] 许珉[1] 刘晖[1] 汪立[1] 张正民[1] 康全清[1] 张全安[1] 王建刚[1] 

机构地区：[1]西安交通大学医学院第二附属医院耳鼻咽喉科,陕西西安710004

出　　处：《现代肿瘤医学》2009年第6期1048-1050,共3页Journal of Modern Oncology

摘　　要：目的:评估喉癌颈淋巴结转移行颈清扫术后的疗效。方法:统计分析我院1990年6月至2000年6月资料完整的喉癌病例356例,病理均为鳞状细胞癌,其中全喉切除73例,近全喉切除11例,喉部分切除256例,拒绝手术而接受放疗或放弃治疗16例(其中3例行气管切开术)。术前颈部触诊、超声、CT、MR、细针穿刺及术中冰冻等方法确定转移淋巴结,同时或之后行颈淋巴清扫术共48例,其中N135例、N29例、N34例,术式:根治性颈清扫8例,改良根治性颈清扫13例(Ⅰ型1例、Ⅱ型4例、Ⅲ型9例,其中双侧清扫2例),选择性颈清扫27例(颈侧清扫17例,Ⅱ、Ⅲ区清扫10例),术后放疗60Gy5例,50Gy23例,40-46Gy8例,12例未行放疗。结果:随访3年以上42例,随访5年35例。术后肿瘤原发部位复发3例,颈部复发6例(术侧5例,对侧1例),远处转移2例(肺和纵隔各1例),死亡5例(2年1例,3-5年4例)。结论:根据肿瘤位置、范围及颈部淋巴结转移情况选择不同的颈清扫术式加术后放射治疗,虽然仍存在复发,但在减少创伤、预防颈清扫术的并发症和疗效等方面收到了较好的效果。Objective：To assess the effect of neck dissection after laryngectomy in laryngeal carcinoma patients with lymphatic metastasis. Methods： A retrospective study was conducted in 356 patients with laryngeal carcinoma from 1990 to 2000. With a diagnosis of squamous cell carcinoma through pathology,73 patients were performed total laryngectomy, 11 cases performed near total laryngectomy and 256 cases partial laryngectomy. The others （16 patients） refused surgery and were treated with radiotherapy only or no treatment（Tracheotomy was done in 3 patients）. Before surgery,all patients were performed neck palpation, ultrasonic, CT, MR, puncture biopsy and tissue section in order to found metastatic lymph nodes. In these cases, lymphatic metastasis were found in 48 patients who were performed neck dissection,in which, N1 35 cases, N2 9 cases and N3 4 cases respectively. Operation methods were radical neck dissection （RND） in 8 cases,modified neck dissection （MND） in 13 cases （type Ⅰ1 case, type Ⅱ 4 cases and type Ⅲ 9 cases ） and selective neck dissection （SND） in 27 cases. After surgery,36 cases received radiotherapy. Results： Forty two cases were followed up for 3 years and 35 cases for 5 years after surgery. Carcinoma recurrence at primary place was found in 3 cases and recurrence at neck in 6 cases（5 cases were on operation side and 1 case on other side）. Tumor remote metastasis were in 2 patients （lung and mediastinum 1 case respectively） ,5 patients died （ 1 case at 2 years after surgery and 4 cases at 3 to 5 years after surgery ）. Conclusion： We can select different neck dissection methods and radiotherapy after surgery according to tumor position, region and neck lymphatic metastasis grade,which is benefit to decrease trauma,prevent complications of neck dissection and improve treatment effect.

关 键 词：喉肿瘤 淋巴转移 颈淋巴结清扫术 

分 类 号：R739.65[医药卫生—肿瘤]