cN0声门上型喉癌颈淋巴结隐匿性转移规律及处理  

Metastatic rule and management of occult lymphatic metastasis in supraglottic cancer with clinically negative neck

作　　者：何洪江[1] 孙冀[1] 顾欣[1] 崔明宇[2] 王丽[1] 贾深汕[1] 

机构地区：[1]哈尔滨医科大学附属第三医院耳鼻咽喉头颈外科,哈尔滨150081 [2]大庆油田总医院骨外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第21期961-964,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：黑龙江省卫生厅科研课题(No:686);黑龙江省政府十一五攻关课题(No:CB05C401-06)

摘　　要：目的:探讨cN0声门上型喉癌患者颈部淋巴结隐匿性转移规律并选择合理的颈清扫区域。方法:139例cN0声门上型喉癌患者在行喉切除术同时行颈淋巴结清扫术,其中行改良性颈清扫57例,肩胛舌骨肌上淋巴结清扫30例,颈Ⅱ、Ⅲ区淋巴结清扫52例。将所获淋巴结按颈部分区逐一行组织病理学检查,观察其转移规律及临床疗效。结果:139例cN0声门上型喉癌患者中,同期行单侧颈清扫113例,同期行双侧颈清扫26例。139例(165侧)颈清扫标本经病理学检查,颈淋巴结阳性36例(25.9%),首次病理学检查颈淋巴结阴性者在随访中发现未手术侧淋巴结转移6例,总颈淋巴结隐匿性转移率为30.2%(42/139),单侧隐匿性转移率为26.6%(37/139),双侧隐匿性转移率为3.6%(5/139)。165侧颈清扫标本共获得淋巴结3 594枚,平均每侧21.8枚,共获病理阳性淋巴结83枚,其中位于Ⅰ区1枚(1.2%),Ⅱ区65枚(78.3%),Ⅲ区16枚(19.3%),Ⅳ区1枚(1.2%),Ⅴ区0枚。颈部复发率为5.0%(7/139),pN0与pN+的颈部复发率分别为0和16.7%(7/42),差异有统计学意义(P<0.05),总5年生存率为76.3%(106/139)。结论:颈Ⅱ、Ⅲ区是cN0声门上型喉癌颈部淋巴结隐匿性转移的主要区域,择区性(Ⅱ、Ⅲ区)颈淋巴结清扫术治疗cN0声门上型喉癌是合适的。To investigate the metastatic rule and management methods of occult lymphatic metastasis in patients with supraglottic cancer. Method：The results of 139 cN0 patients with supraglottic cancer treated by neck dissection（ND） were reviewed retrospectively. Each lymph node was studied pathologically in order to define the level of the lymph node metastasis. Result：Of the 139 patients with supraglottic cancer and cN0 neck, 113 cases received ipsilateral ND and 26 cases with bilateral ND. Thirty-six（25.9%）of 139 patients were found to have occult lymphatic metastasis on pathological examination,6 patients without metastasis in dissected side at pathologic examination showed metastasis in the contralateral undissected neck later. Therefore the total occult metastasis rate was 30.2%（42 of 139）. The unilateral and bilateral neck occult metastases were determined in 37 cases（26.6%）and 5 cases（3.6%）respectively. A total of 3 594 lymph nodes were harvested in 165 specimens, with 83 positive nodes. The distributions of the 83 positive nodes were as follows： level I 1. 2% （1 node）, level Ⅱ 78. 3%（65nodes） ,Level Ⅲ 19.3%（16 nodes）,level Ⅳ 1.2%（1 node）,level Ⅴ （0 node）. The 3-year regional recurrence rate was 5.0%（7/139）. The 5-year survival rate was 76. 3%（106/139）. Patients with positive neck metastasis had higher regional recurrence rates（P〈O. 05）. Conclusion： Occult metastasis rate of supraglottic cancer is as high as 30.2%, the selective lateral neck dissection of level Ⅱ, Ⅲ is recommended.

关 键 词：喉肿瘤 隐匿性转移 颈淋巴结清扫术 癌 鳞状细胞 

分 类 号：R739.65[医药卫生—肿瘤]