喉前淋巴结转移对声门型喉癌治疗的指导作用  

The guiding role of prelaryngeal lymph node metastasis in the treatment of glottic carcinoma

作　　者：蔡志良 林忠豪 陈缪安 李聪 

机构地区：[1]福建医科大学附属闽东医院宁德市闽东医院耳鼻咽喉头颈外科,福建宁德352000 [2]上海交通大学医学院附属同仁医院耳鼻咽喉科,上海200050

出　　处：《中国耳鼻咽喉颅底外科杂志》2017年第6期555-558,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨声门型喉癌喉前淋巴结转移的规律,为改进喉癌规范手术提供依据。方法回顾性分析2006年1月~2015年12月手术方式治疗的73例声门型喉癌患者的病例资料,比较早期喉癌和中晚期喉癌之间、喉前淋巴结阳性组和阴性组之间的肿瘤分期、病理分型、术后颈部淋巴结转移、术后局部复发和生存时间的差异。结果 73例声门型喉癌患者中喉前淋巴结阳性率4例,阳性率5.47%(4/73)。中晚期喉癌(Ⅲ期、Ⅳ期)比早期喉癌(Ⅰ、Ⅱ期)更容易发生颈部淋巴结转移和喉前淋巴结转移,差异均具有统计学意义(P<0.05)。喉前淋巴结转移、颈部淋巴结转移均与病理分型差异无统计学意义(P>0.05)。中晚期喉癌较早期喉癌更容易发生术后淋巴结转移;喉前淋巴结阳性比阴性更容易发生术后淋巴结转移;差异均具有统计学意义(P<0.05)。中晚期喉癌较早期喉癌更容易发生术后局部复发;喉前淋巴结阳性比阴性更容易发生术后局部复发;差异均具有统计学意义(P<0.05)。喉前淋巴结阳性比阴性组生存时间短,差异具有统计学意义(P<0.05)。结论喉前淋巴结转移在中晚期喉癌中发生率较高,应常规予以清扫。发生喉前淋巴转移的患者术后颈部淋巴结转移和术后局部复发几率均增加,预后较差,提示需要术后进一步治疗的必要性。Objective To investigate the regnlarity of prelaryngeal lymph node metastasis in glottic carcinoma, in order to provide evidence for improving standard operation of laryngeal carcinoma. Methods Clinical data of 73 patients with glottic carcinoma surgically treated from Jan 2006 to Dec 2015 were analyzed retrospectively. The tumor stage, pathological type, postoperative neck lymph node metastasis, local recurrence and survival time were compared between the patients with early and middle-advanced laryngeal carcinoma, and those with and without prelaryngeal lymph node metastasis. Results In 73 cases of glottic carcinoma, the prelaryngeal lymph node metastasis was found in 4 with a positive rate of 5.47% （4/73）. The patients with laryngeal carcinoma of middle-advanced stages （stage Ⅲ and Ⅵ） were more likely to develop cervical lymph node metastasis and prelaryngeal lymph node metastasis than those of early stages （stage Ⅰ and Ⅱ）, and the differences were statistically significant （ P 〈 0.05 ）. The differences of both cervical and prelaryngeal lymph node metastases between pathological types of well differentiation and poor to moderate differentiation were statistically insignificant （ P 〈 O. 05 ）. Postoperative lymph node metastasis and local recurrence were more likely to occur in laryngeal carcinomas of middle- advanced stage than in those of early stage, and the postoperative lymph node metastasis and local recurrence were also more likely to occur in laryngeal carcinomas with prelaryngeal lymph node metastasis than in those without. The differences were all statistically significant（ P 〈 0.05 ）. The survival time of the patients with prelaryngeal lymph node metastasis was shorter than that of those without, and the difference was statistically significant （ P 〈 0.05 ）. Conclusions With high incidence of prelaryngeal lymph node metastasis in advanced laryngeal carcinoma, these lymph nodes should be dissected routinely. Due to increase of postoperative cervical lymph nod

关 键 词：肿瘤转移 喉肿瘤 颈廓清术 

分 类 号：R739.65[医药卫生—肿瘤]