声门上型喉癌的分区性颈清扫术

Selective neck dissection in the treatment of supraglottic carcinoma

目的：探讨分区性（局限性）颈清扫术治疗声门上型喉癌的作用。方法：根据喉的淋巴引流解剖特点，设计了上颈淋巴结清扫术（颈内静脉上组）。对1976～1990年入院治疗的168例声门上型喉癌患者（其中N0149例，N119例）采用了此术处理颈部。结果：168例上颈淋巴结病理检查均无淋巴结转移。5年观察后有17例出现颈部转移，其颈部复发率与经典性全颈清扫术后相同。全组5年生存率为72．6％（122／168）。结论：对声门上型喉癌N0或部分N1患者以分区性颈清扫术如上颈清扫术作为治疗措施，创伤小，手术时间短，术后恢复快，肿瘤学治疗效果与经典性全颈清扫术相同。

To study the effectiveness of selective neck dissection (upper neck dissection,UND) in the treatment of No neck of supraglottic carcinoma. Method:The upper neck dissection was designed according to the lymphatic drainage of the supraglottic larynx for the management of N0 neck. The records of the supraglottic carcinoma of T1~4 N0~1M0 cases (168 patients), who were treated in 1976~1990 at this hospital, were analysed retrospectively. Result:In this seires of 168 patients with no neck metastases pathologically a follow-up of five years after an upper neck dissection revealed a neck recurrence rate of 10. 1 % (17/168),which is comparable with those reported in the literature after selective neck dissection. Five year survival rate was 72. 6% (122/168). Conclusion: Long-termed observation after UND for supraglottic carcinoma (T1~4N0~1) resulted in satisfactory survival rates and regional control. It seems justifiable to do a selective neck dissection for No and selected N1 patients in order that more patients were exempted from enduring the morbidity following a comprehensive neck dissection.