喉癌临床N_0患者颈淋巴结转移的病理研究

A clinical and pathological study on cervical lymph node metastasis in the clinical N0 patient with laryngeal carcinoma

目的探讨喉癌临床Ｎ０患者颈淋巴结转移特点，为颈淋巴结处理方式选择提供根据。方法４０例临床Ｎ０喉癌患者被随机分为选择性根治性颈廓清术（ｒａｄｉｃａｌｎｅｃｋｄｉｓｅｃｔｉｏｎ，ＲＮＤ）及功能性颈廓清术（ｆｕｎｃｔｉｏｎａｌｎｅｃｋｄｉｓｅｃｔｉｏｎ，ＦＮＤ）两组，分别完成１３及２７例。将获得淋巴结逐一行病理检查，以确定转移情况。结果ＲＮＤ组平均每侧获淋巴结３４．２枚，ＦＮＤ组为２７．４枚，差异无显著性（ｔ＝０．８６，Ｐ＞０．０５）。两组颈淋巴结转移率分别为３０．８％（４／１３）及３３．３％（９／２７），总转移率为３２．５％（１３／４０）。１３例颈淋巴结转移阳性病例中１２例（９２．３％）转移淋巴结位于Ⅱ，Ⅲ区。３３枚转移阳性淋巴结中３２枚（９６．９％）位于第Ⅱ和Ⅲ区。两组３年生存率分别为６９．２％（９／１３）及７７．８％（２１／２７），统计学差异无显著性（χ２＝０．３４１８，Ｐ＞０．５），总的３年生存率为７５％（３０／４０）。结论对临床Ｎ０喉癌患者行肩胛舌骨肌上或侧颈廓清术较为适宜。

Objective To study the characteristics of the cervical lymph node metastasis in negative nodes(N0) with clinically with laryngeal carcinoma patients and its implication in clinical treatment. MethodsWT5BZForty patients with laryngeal carcinomas of No category were divided randomly into two groups: 13 radical neck dissections (RND) and 27 functional neck dissections (FND) were performed. Lymph nodes were studied histologically. ZResults On an average, 34.2 lymph nodes were obtained in one side of neck in RND group, and 27.4 in FND group (t=0.86, P>0.05). The metastases rates were 30.8%(4/13) in RND group and 33.3%(9/27) in FND group, and the total metastasis rate was 32.5%(13/40). Twelve of 13 patients (92.3%) who had positive nodes involved only the levels and , and 32 of 33 positive nodes (96.9%) were located in the levels and . The 3year survival rates of the two groups were 69.2%(9/13) and 77.8%(21/17), respectively with no statistical difference (2=0.3418, P>0.5). Total 3year survival rate was 75% (30/40). Conclusion The supraomohyoid (level I II and III) or lateral neck (level II, III and IV) dissections seem suitable for the treatment laryngeal carcinoma patients with clinically negative neck nodes.