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目的探讨声门上型喉癌颈淋巴隐匿性转移规律及其处理方法。方法选择术前未行放疗、化疗的声门上喉鳞状细胞癌,临床N0M0病例,共30例,男19例,女11例;年龄40~72岁,平均548岁;按UICC(1997年)标准分期T28例,T318例,T44例。行主病变侧肩胛舌骨肌上颈清扫术(supraomohyoidneckdissecton,SOHND),将获得淋巴结逐一行病理组织学检查,观察其转移规律及临床治疗效果。结果首次颈清扫术30例中有6例颈淋巴结转移癌阳性,在2~3年随访中有3例发生对侧颈淋巴结转移,计有9例颈淋巴转移,隐匿性转移率同侧为20%(6/30),对侧为10%(3/30)。颈清扫术共获淋巴结527个,平均每侧176个。获转移阳性淋巴结10个,其中Ⅱ区9个,Ⅲ区1个,Ⅰ区无癌转移。喉及主病变侧颈部均无复发,2年无瘤生存率867%(26/30)。结论声门上型喉癌颈淋巴结隐匿性转移率达30%,采用Ⅱ、Ⅲ区的择区性颈清扫术处理其颈淋巴结(Ⅰ区可不必作为常规清扫区域)是切实可行的。
Objective To investigate the occult metastasis of cervical lymph of supraglottic laryngeal carcinoma and its treatment. Methods Thirty patients with supraglottic laryngeal squamous cell carcinoma without chemotherapy and chemotherapy were enrolled in this study. There were 30 males and 19 females, 11 females, aged 40-72 years, with an average age of 548 years. According to UICC (1997 ) Standard staging T28 cases, T318 cases, T44 cases. Primary supraspinatus hyponatreus supraomohyoid neck dissection (SOHND) is performed to determine the pathological changes of the lymph nodes and the clinical effects. Results Among the 30 cases of the first neck dissection, 6 cases were positive for cervical lymph node metastasis. Three cases had metastatic cervical lymph nodes at 2 to 3 years. There were 9 cases of cervical lymph node metastasis with the occult metastasis rate of 20 % (6/30), contralateral 10% (3/30). Neck dissection achieved a total of 527 lymph nodes, with an average of 176 per side. There were 10 positive lymph nodes metastasized, including 9 in area Ⅱ, 1 in area Ⅲ and no metastasis in area Ⅰ. There were no recurrences in the larynx and the main lesion and the neck. The 2-year disease-free survival rate was 867% (26/30). Conclusions The occult metastasis rate of cervical lymph nodes in supraglottic laryngeal carcinoma is 30%. It is practicable to treat cervical lymph nodes by using selective regional neck dissection in area Ⅱ and Ⅲ (Ⅰ area may not be used as routine cleaning area).