鼻咽癌放疗后残留和复发颈淋巴结的分布规律

Distribution of Recurrent and Persistent Lymph Node of Nasopharyngeal Carcinoma after Radiotherapy

【目的】了解鼻咽癌颈淋巴结分布规律是选择手术方式的前提,但关于这方面资料少见。本研究分析鼻咽癌初诊、放疗后残留和复发颈淋巴结分布规律,希望为手术方式选择提供理论基础。【方法】回顾性分析88例颈淋巴结残留和复发的鼻咽癌患者资料,分析初诊、残留和复发淋巴结位置及各位置间相互关系,分析残留、复发与初诊时T、N分期关系。【结果】①鼻咽癌放疗后残留和复发颈淋巴结都是以Ⅱ区为主(55.6%和58.6%),其次是Ⅲ区,而Ⅳ、Ⅴ、Ⅰ区则较少,但经病理学证实的Ⅳ、Ⅴ、Ⅰ区淋巴结比临床发现的为多。②累及Ⅱ区者23.6%都为伴随其他区同时出现,累及Ⅲ区者有63.6%都伴有Ⅱ区累及,累及Ⅳ区者有88.9%伴随有Ⅲ区累及,而累及Ⅱ区(76.4%)、Ⅴ区(42.7%)者以单独出现者为多。③N2+N3者发生颈淋巴结残留和复发的几率大于N0+N1者(75.8%vs.24.2%,x^2=9.268,P=0.002)。【结论】高N分期的淋巴结易于残留和复发,但残留和复发往往都是集中在Ⅱ区,并且Ⅲ区、Ⅳ区残留和复发者往往有上级淋巴结累及,而Ⅱ区和Ⅴ区往往是单独出现为多。

[Objective] The distribution of lymph node of nasopharyngeal carcinoma is the base to chose the surgical modalities, but few data about this were found. The aim of this study was to investigate the distribution rule of untreated lymph nodes, recurrent and persistent lymph nodes after radiotherapy. [ Methods ] The clinical data of 88 cases of nasopharyngeal carcinoma with recurrent and persistent lymph nodes were analyzed retrospectively, the levels involved by lymph nodes and relationship among the levels were analyzed, the initial lymph nodes of those with recurrent and persistent lymph nodes were analyzed. [Results] 1. The recurrent and persistent lymph nodes mainly located in level Ⅱ （55.6% and 58.6%, respectively）, next is level Ⅲ and rarely in level Ⅳ, Ⅴ and Ⅰ , but real chance of levels Ⅳ, Ⅴ and Ⅰ involved was relatively more than clinical examination. 2. Usually, the patients with lymph nodes involved in level Ⅲ and Ⅳ have other levels involved simultaneously, the percentage were 23.6%, 63.6% and 88.9% respectively, but lymph node in level Ⅱ , Ⅴ mainly isolated. 3. Those with higher N stage were susceptibile to recur and persist after radiotherapy （75.8% vs. 24.2%, χ^2 = 9.268, P = 0.002）. [ Conclusion] The patients with higher N stage were susceptibile to recur and persist and they mainly located in level Ⅱ , but the lymph node found in level Ⅲ or Ⅳ usually with the ahead levels involved and level Ⅱ and level Ⅴ mainly involved isolatedly.