颈清扫术在声门上型喉癌治疗中的作用  

Neck dissection in supraglottic carcinoma

作　　者：赵宁[1] 李巍[1] 王琰[1] 郭星[1] 潘子民[1] 姜学钧[1] 

机构地区：[1]中国医科大学附属第一医院耳鼻咽喉科,辽宁沈阳110001

出　　处：《实用肿瘤杂志》2014年第2期123-126,共4页Journal of Practical Oncology

基　　金：国家自然科学基金项目(81102057)

摘　　要：目的探讨颈清扫术在声门上型喉癌治疗中的作用。方法总结448例声门上型喉癌患者的临床治疗及生存情况,其中T12例,T2175例,T3140例,T4131例。N+173例,占声门上型喉癌的38.6%。采用喉部分切除术173例,喉全切除术275例。同期颈清扫术396例(88.4%)(单侧168例,双侧228例)。223例N0病例行改良全颈清扫术,173例N+病例行经典全颈清扫术,52例N0患者未行颈清扫术。结果直接法统计其3年生存率为75.2%(337/448),5年生存率为52.2%(234/448)。N0患者3年生存率为78.9%(217/275),5年生存率为69.8%(192/275)。N+患者3年生存率为69.4%(120/173),5年生存率为24.3%(42/173),二者比较差异均有统计学意义(P<0.05,P<0.01)。Ⅰ、Ⅱ期123例,Ⅲ、Ⅳ期325例,5年生存率分别为76.4%(94/123)及43.1%(140/325),二者差异有统计学意义(P<0.01)。在颈部转移二次住院手术的44例中,其5年生存率仅为34.1%(15/44)。结论喉癌早期病例疗效明显好于晚期病例。声门上型喉癌N0时同期行必要的择区性颈清扫术是提高疗效的重要措施。Objective To evaluate the application of neck dissection in supraglottic carcinoma. Methods The clinical data of 448 patients with supraglottic carcinoma were retrospectively reviewed. There were 2 cases of Z1 , 175 cases of T2 ,140 cases of T3 and 131 cases of T4. There were 173 N ＋ cases （38.6%）. One hundred and seventy three cases underwent partial laryngectomy and 275 cases underwent total laryngectomy. Simultaneous neck dissection was undertaken in 396 cases （168 unilateral,228 bilateral）, accounting for 88.4% of total cases. Two hundred and twenty three No cases underwent modified radical neck dissection, 173 N ＋ cases underwent radical neck dissection and 52 NO cases did not undergo neck dissection. Results The 3- and 5-year survival rates were 75.2% （337/448） and 52.2% （234/448） respectively. The 3- and 5-year survival rates of No cases were 78.9% （217/275） and 69.8% （ 192/275 ） respectively, while those of N ＋ patients were 69.4% （120/173） and 24.3% （42/173） respectively. The differences between them were statistically significant （P 〈0. 05 ,P 〈0.01 ）. The 5-year survival rates of stage [ and II patients and stage ]II and IV patients were 76.4% （94/123） and 43.1% （ 140/325 ）, respectively （ P 〈 0.01 ）. The 5-year survival rate of patients with twice neck dissection due to neck metastasis was 34.1% （ 15/44）. Conclusion The outcome of early stage supraglottic carcinoma is much better than that of late stage. In NO supraglottic carcinoma simultaneous selective neck dissection is important for outcome improvement.

关 键 词：喉肿瘤 病理学 癌 鳞状细胞 癌 鳞状细胞 外科学 声门 外科学 喉切除术 方法 颈淋巴结清扫术 方法 存活率 预后 

分 类 号：R739.65[医药卫生—肿瘤] R730.56[医药卫生—临床医学]