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目的探讨头颈部恶性肿瘤咽后间隙淋巴转移的临床表现、手术方法及其疗效。方法总结伴咽后间隙淋巴结肿大的6例头颈恶性肿瘤患者的临床表现。其中,声门上型喉癌(T3N2M0)2例(高、中分化鳞癌各1例)、下咽中分化鳞癌(T3N2M0)、口咽中分化鳞癌(T2N2M0)、鼻腔恶性黑色素瘤(TXN2M0)及甲状腺乳头状癌(TXN2M0)各1例。由CT和(或)MRI影像测得咽后间隙肿大淋巴结的直径为1.5~2.5cm.在控制原发灶和颈部转移淋巴结的基础上行咽后间隙淋巴清扫,并单独送病理检查。结果6例咽后间隙清扫标本均见转移,均为单发。其中1/2者4例,1/3者2例,且均伴颈内静脉链淋巴转移,分别为3/15,3/17,4/19,5/19,6/20和6/23。无颅神经损伤和咽瘘发生。下咽癌患者2年后死于肺转移;鼻腔恶性黑色素瘤者第3次手术后14个月复查时无复发,后失访;口咽癌患者术后18个月局部复发,2年后死亡。其余3例患者随访2~4年均无瘤生存。结论CT和MRI是诊断咽后间隙淋巴转移的主要手段,该处淋巴清扫是比较安全的。
Objective To investigate the clinical manifestations, surgical methods and curative effects of pharyngeal space lymphatic metastasis in head and neck malignant tumors. Methods The clinical manifestations of 6 cases of head and neck malignant tumor with posterior pharyngeal lymph node enlargement were summarized. Among them, there were 2 cases of supraglottic laryngeal cancer (T3N2M0), 1 case of high and medium grade squamous cell carcinoma, 3 cases of moderately differentiated squamous cell carcinoma (T3N2M0), 2 cases of moderate orifocal squamous cell carcinoma (T2N2M0) TXN2M0) and thyroid papillary carcinoma (TXN2M0) in 1 case. The diameter of the posterior pharyngeal enlargement lymph nodes measured by CT and / or MRI images was 1.5-2.5 cm. Lymph node dissection was performed on the basis of controlling the primary tumor and cervical lymph node metastasis, and pathological examination was performed separately. Results 6 cases of retropharyngeal clearance were seen in the transfer of specimens were single. 4 of them were in 1 case and 2 of 1 in 3, all of which were accompanied by cervical lymphatic metastasis of internal jugular vein, which were 3/15, 3/4, 3/9, 5/19, 6/20 and 6/23 respectively . No cranial nerve injury and pharyngeal fistula occurred. Hypopharyngeal cancer patients died of pulmonary metastasis 2 years later; nasal malignant melanoma without recurrence after 14 months of the third surgery, followed by loss of follow-up; local recurrence of oropharyngeal cancer 18 months after surgery, 2 years after the death . The remaining 3 patients were followed up for 2 to 4 years were tumor-free survival. Conclusion CT and MRI are the main means to diagnose the lymphatic metastasis in the posterior pharyngeal space. Lymph dissection in this area is safe.