声门上型喉癌颈淋巴结转移的临床病理研究

Clinical and pathological study on cervical lymph node metastasis of supraglottic cancer

目的：观察声门上型喉癌颈淋巴结转移病理学特点，以及颈淋巴结转移和原发病变的关系。方法：１００例声门上型喉癌和颈廓清标本经火棉胶包埋、进行连续切片光镜观察。结果：①颈淋巴结转移５５例，转移率５５％；②颈淋巴结转移分四类：临床病理转移２９例，病理转移２６例，临床转移５例，无转移４０例；③转移淋巴结分四期：癌早期、癌长期、癌满期、破膜期；④转移淋巴结分三型：单发型、多发型和融合型；⑤声门上型喉癌不同发病率部位癌转移率为：杓会皱襞８５．７％，杓区６６．６％，会厌室带５６．８％，会厌４６．４％，室带４５．４％；⑥声门上型喉癌扩展到喉外者转移率为８０％～８４％。结论：声门上型喉癌有较高的颈淋巴结转移率，在转移淋巴结中融合型居多，破膜率高。分析肿瘤发病部位可帮助预测颈淋巴结转移。

Aim: To study pathological features of cervical lymph node metastasis and the relationship between supraglottic cancer and cervical lymph node metastasis. Method: Observation of 100 wholeorgan serial sections of the larynges and 170 sides of the radical neck dissection specimens. Results: ①Cervical lymph node metastasis 55 cases, metastatic rate 55%; ②Four series of cervical metastasis: clinicopathologic metastases(29 cases), pathologic metastases(26 cases), clinical metastases(5 cases), no metastasis (40 cases). ③Four stages of metastatic lymphnode: early stage, growth stage, fullness stage and capsular perforative stage; ④ Three types of metastases: single type (21cases), multiple type (10 cases) and aggregated (24 cases) type. ⑤ Metastatic rates of supraglottic cancer of different regions: aryepiglottic fold 85.7%, arytenoid cartilage area 66.6%, epiglottoventricular fold 56.8%, epiglottic 46.4%, ventricular fold 45.4%. ⑥When the tumour spread to the perilaryngeal region, the metastatic rate was 80% to 84%. Conclusion: Metastatic rate of cervical lymph node is higher in supraglottic cancers, the aggregated type and capsular perforative stage are more in metastasis lymph nodes. Analysis the original sites of supraglottic cancer is conducive to the prediction of the cervical lymph node metastasis.