喉及下咽部鳞癌颈淋巴结转移的相关研究

Cervical lymphatic metastasis of squamous cell carcinoma of larynx and hypopharynx

目的探讨喉及下咽部鳞癌颈转移的特点、规律。方法收集喉及下咽部鳞癌75例(108侧)颈淋巴结标本,按颈部解剖分区进行病理检查确定颈转移情况。结果喉及下咽癌颈转移均以Ⅱ区为高发区,转移率分别为34.1%和73.9%。喉癌颈转移与T分级及淋巴结分期有关系。下咽癌颈转移与T分级和淋巴结分期均无明显关系。24.0%淋巴结发生包膜外侵犯,其中69.2%(9/13)破膜后可侵犯周围组织。结论喉癌颈转移与T分级和淋巴结分期有关,颈淋巴结直径在3.0cm以下发生包膜外侵犯率低,行保留胸锁乳突肌或用其制作肌瓣是较安全的。

Objective To study the characteristic of cervical node metastasis in the head and neck squamous carcinoma. Methods The specimens of patients undergoing neck dissection were carefully examined to confirm the distribution of cervical lymph node metastases in 75 cases （108 sides,including 85 sides of laryngocarcinoma and 23 sides of hypopharyngeal carcinoma）. Results Level Ⅰ area were the most commonly involved part of cervical lymph node metastases for laryngocarcinoma and hypopharyngeal carcinoma and the rates of lymph node metastases were 34. 1 %（29/85）and 73.9 % （17/23） respectively. In a univariate analysis,it was confirmed that the following variables of tumor T staging and the size of cervical lymph node were correlated to cervical lymph node metastases for laryngocarcinoma and the aforesaid variables had no statistical difference for hypopharyngeal carcinoma. The peplos of cervical lymph node were encroached at the rate of 24% （13/54）. The sternocleidomastoid muscle and internal jugular vein were involved at the rate of 69.2% （9/13）, in which the peplos of cervical lymph node were offended. Conclusion T staging and the size of cervical lymph node are correlated to cervical lymph node metastases of laryngocarcinoma and hypopharyngeal carcinoma. It is safe to perform head and neck reconstruction by sternomastoid muscle island flap if the cervical lymph node diameter is smaller than 3 diameters in squamous cell carcinoma of the head and neck.