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目的探讨喉癌同侧颈部淋巴结转移癌穿透包膜的相关因素及其与对侧颈部淋巴结转移和患者预后的关系。方法对184例喉癌患者进行手术治疗的同时,行经典或改良经典颈廓清术,对颈廓清标本采用透明淋巴结摘出连续切片法,摘出淋巴结,并进行病理检查。采用Kaplan- Meier方法对随访资料进行生存分析。结果184例喉癌患者中,颈部淋巴结转移癌80例,其中穿透包膜26例,穿透包膜率为32．5%。单因素分析结果表明,淋巴结转移癌是否穿透包膜与病理N分期和同侧颈部淋巴结转移数有关。淋巴结转移癌穿透包膜者同侧颈部复发转移率(34．6%)、对侧颈部转移率(46．2%)均高于未穿透包膜者。淋巴结转移癌穿透包膜患者3、5年生存率分别为53．9%和23．1%,其生存率低于未穿透包膜患者。结论淋巴结转移癌是否穿透包膜与病理N分期和同侧颈部淋巴结转移数有关。淋巴结转移癌穿透包膜患者的对侧转移率高,应行双颈廓清术。淋巴结转移癌穿透包膜是影响患者预后的重要因素,病理科应当检查转移淋巴结被膜是否穿破,并予以报告。
Objective To investigate the related factors of penetrating the capsule of ipsilateral cervical lymph node metastasis of laryngeal cancer and its relationship with the contralateral cervical lymph node metastasis and prognosis. Methods 184 cases of laryngeal cancer patients undergoing surgical treatment at the same time, the classic or modified classic neck dissection, clear neck specimens using clear lymph node dissection serial sections removed lymph nodes, and pathological examination. Survival analysis of follow-up data was performed using Kaplan-Meier method. Results Among the 184 patients with laryngeal carcinoma, 80 cases were metastatic to cervical lymph nodes, of which 26 cases penetrated the capsule and the penetrating envelope rate was 32.5%. Univariate analysis showed that whether lymph node metastasis penetrated the envelope was related to pathological N stage and ipsilateral cervical lymph node metastasis. Lymphatic metastatic carcinoma of the ipsilateral neck through the capsule of the recurrence and metastasis rate (34.6%), contralateral neck metastasis rate (46.2%) were higher than those who did not penetrate the capsule. The 3-year and 5-year survival rates of patients with lymph node metastatic carcinoma penetrating enamel were 53.9% and 23.1%, respectively, which were lower than those without envelopment. Conclusion The lymph node metastasis of the penetrating envelope and pathological N stage and ipsilateral neck lymph node metastasis number. Lymph node metastases in patients with penetrating envelopment of the contralateral metastasis rate should be double-necked clear surgery. Lymphatic metastasis of cancer through the envelope is an important factor affecting the prognosis of patients, the pathology should check the transfer of lymph node capsule is worn, and be reported.