择区性颈清扫术治疗下咽鳞状细胞癌颈部淋巴结转移的术式探讨  

Selective neck dissection and the management of the hypopharyngeal cancer

作　　者：丛铁川[1] 赵恩民[1] 肖水芳[1] 王全桂[1] 吴园丁[1] 沈泓[1] 李天成[1] 秦永[1] 

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科,北京100034

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第6期241-244,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨择区性颈清扫术(SND)治疗下咽鳞状细胞癌颈部淋巴结转移的手术范围。方法:回顾性分析接受SND的26例下咽癌患者,其中11例cN0患者,15例cN+患者。本组共有51侧的SND,其中34侧为选择性SND,17侧为治疗性SND。结果:发现隐匿性颈淋巴结转移6例(55%),颈淋巴结转移均限制在Ⅱ区和Ⅲ区内。cN+患者均证实有颈淋巴结转移,其中Ⅱ区转移占66.7%,Ⅲ区转移占86.7%,Ⅳ区转移占46.7%,Ⅴ区转移占20.0%,另外Ⅰ区仅1例发现转移(6.7%)。随访发现区域复发4例,均为cN+患者,且均未见Ⅰ区复发。结论:cN0下咽癌患者SND(Ⅱ～Ⅲ)清扫有一定的临床意义,尚需进一步验证;cN+患者Ⅰ区清扫尚无必要,SND(Ⅱ～Ⅴ)配合术后放疗能取得满意的疗效。Objective：To determine the most appropriate form of selective neck dissection（SND） in the hypopharyngeal cancer with cervical lymph node metastasis.Method：We have retrospectively analyzed the distribution and prevalence of cervical metastasis in 26 patients with hypopharyngeal squamous cell carcinoma from January 1998 to December 2008.All the patients underwent SND as part of the primary treatment.There were 34 elective SNDs and 17 therapeutic SNDs from 11 node-negative hypopharyngeal cancers and others node-positive.Result：Occult metastasis was found in 6 patients（55%） with cervical metastasis confined to level Ⅱ and Ⅲ.Clinical node-positive necks were all pathologically identified with 6.7%,66.7%,86.7%,46.7%,and 20.0% of the prevalence of metastasis to level Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ respectively.The regional recurrences were found in 4 patients during the follow-up,which were all from cN＋ patients.No patient experienced level Ⅰ recurrence.Conclusion：The results of this study suggest that SND（Ⅱ-Ⅲ） may be feasible for the treatment of cN0 hypopharyngeal cancer,which needs a larger sample to verify.Meanwhile,from our data,it has a satisfactory result to perform SND（Ⅱ-Ⅴ） with adjuvant radiotherapy for the cN＋ patients.

关 键 词：择区性颈清扫术 下咽肿瘤 淋巴转移 

分 类 号：R739.6[医药卫生—肿瘤]