声门上型喉癌cN0转移规律的临床研究  

A clinical study on metastasis regularity of supraglottic laryngeal carcinoma cN0

作　　者：李慧[1] 刘诗娴 王梦君 张俊杰 蔡常琦 张明洁[1] 王晓敏[1] 韩跃峰[1] 马士崟[1] LI Hui(Department of otolaryngology-head and neck surgery,first affiliated hospital of Bengbu Medical College,Bengbu,Anhui,233004,China)

机构地区：[1]蚌埠医学院第一附属医院耳鼻咽喉头颈外科,安徽蚌埠233004

出　　处：《齐齐哈尔医学院学报》2020年第10期1201-1204,共4页Journal of Qiqihar Medical University

基　　金：蚌埠医学院科技发展基金项目(BYKF1790);蚌埠医学院科技发展基金项目(BYKF1855);安徽省教育厅重点科技项目(KJ2019A0376)。

摘　　要：目的探讨声门上型喉癌cN0颈部各区淋巴结早期转移的规律,并为高选择颈清扫提供理论依据。方法选择2016年12月—2018年12月本院耳鼻咽喉-头颈外科收治的26例声门上型喉癌cN0的病例行选择区性颈清扫术。术后颈部标本均在新鲜情况下,以术中分区标记部位予以分割、固定后送病理切片。术前的TNM分期和术后病理的结果按颈部淋巴结分区和原发肿瘤的分化程度行统计分析。结果 26例患者中单侧择区性颈清扫14例,双侧性择区性颈清扫12例。共计行38侧择区性颈清扫。其中8例行单侧颈外侧清扫:其中4例T2、4例T3;6例行单侧肩胛舌骨上颈清扫:其中3例T1、3例T2;11例行双侧颈外侧清扫:其中8例T3、3例T4;1例T4行双侧颈后外侧清扫。共收集到9例病例淋巴结转移阳性,阳性率为34.6%。其中单侧转移6例,占23.1%;双侧转移3例占11.5%。共发现阳性淋巴结14枚,在各区的分布为Ⅱ区10(71.4%)枚其中Ⅱa区3(21.4%)枚Ⅱb区7(50.0%)枚;Ⅲ区3(21.4%)枚;Ⅳ区1(7.1%)枚。转移的9例患者在TNM分期中T2单侧转移2例:2枚在瘤体主侧Ⅱ区;T3单侧转移3例:3枚在瘤体主体侧Ⅱ区,双侧转移2例:2枚在瘤体主体侧Ⅱ区2枚在瘤体对侧Ⅱ区1枚在瘤体主体侧Ⅲ区;T4单侧转移1例:1枚在瘤体主体侧Ⅲ区,双侧转移1例:1枚在瘤体主体侧Ⅲ区1枚在瘤体对侧Ⅱ区。颈淋巴结转移T1期0.0%,T2期28.6%,T3期41.7%,T4期50.0%。其中高分化鳞癌的颈淋巴结转移率为33.3%;中分化鳞癌的颈淋巴结转移率为37.5%;低分化鳞癌的颈淋巴结转移率为33.3%。结论声门上型喉癌cN0患者有高的颈淋巴结转移率;原发肿瘤的分化程度与肿瘤颈部淋巴结转移无关(P>0.05),肿瘤的T分期与肿瘤颈部淋巴结转移有关(P<0.05),随临床分期的增加颈淋巴结转移率升高;声门上型喉癌患者cN0病例行重点行Ⅱ和Ⅲ区尤其是Ⅱb区为主要的择区性清扫能有效清除潜在的淋巴结转移。Objective To investigate the pattern of early lymph node metastasis of supraglottic laryngeal carcinoma cN0 in neck regions, and to provide theoretical basis for high-selective neck dissection.Methods Selective neck dissection was performed on 26 cases of patients those with supraglottic laryngeal cancer cN0 admitted to department of otolaryngology-head and neck surgery of the first affiliated hospital of Bengbu medical college from December 2016 to December 2018. All postoperative specimens from the neck were sectioned and fixed depend on intraoperative labeled sites under fresh conditions, and then sent to pathological sections. Preoperative TNM staging and postoperative pathological results were statistically analyzed according to the cervical lymph node region and the degree of differentiation of the primary tumor. Results Among the 26 patients, there were 14 cases of unilateral selective dissection and 12 cases of bilateral selective dissection. A total of 38 selective neck dissections were performed. Unilateral lateral neck dissection was performed in 8 cases, including 4 cases of T2 and 4 cases of T3. Unilateral omohyoideus neck dissection was performed in 6 cases, including 3 cases of T1 and 3 cases of T2. Bilateral lateral neck dissection was performed in 11 cases, including 8 cases of T3 and 3 cases of T4. Bilateral posterolateral neck dissection was performed in 1 case(T4). A total of 9 cases with positive lymph node metastasis were collected, with a positive rate of 34.6%. Among them, 6 cases(23.1%) of unilateral metastasis. Bilateral metastasis observed in 3 cases, which accounted for 11.5%. A total of 14 positive lymph node was found, and 10(71.4%) positive lymph node distributed in Ⅱ area, among which 3(21.4%) in IIa section and 7(50.0%) in IIb section. 3(21.4%) in Ⅲ area, and 1(7.1%) in Ⅳ area. Among the 9 transfer cases, there were 2 cases of patients with T2 stage(according to TNM staging) occurred unilateral transfers. Both two cases were in main side Ⅱ area of the tumor.T3 unilateral t

关 键 词：颈淋巴结清扫术 淋巴结转移 鳞状细胞 功能 

分 类 号：R322.25[医药卫生—人体解剖和组织胚胎学]