颈Ⅱ和Ⅲ区清扫术治疗cNO声门上型喉鳞状细胞癌

Neck dissection of levels Ⅱ and Ⅲ for the treatment of supraglottic cancer with clinically negative neck

目的 研究择区性即ⅡA、ⅡB和Ⅲ区颈淋巴结清扫术（selective neck dissection,SND）治疗临床颈淋巴结阴性（clinical node negative,cN0）的声门上型喉鳞癌隐匿性颈转移的可行性.方法 回顾性分析2002年10月至2006年3月在哈尔滨医科大学肿瘤医院头颈外科行SND（ⅡA、ⅡB和Ⅲ区）治疗52例cN0声门上型喉癌的治疗结果.结果 52例cNO声门上型喉癌中32例同期行单侧（ⅡA、ⅡB和Ⅲ区）,20例行双侧SND.52例颈清扫标本病理检查发现,颈转移阳性者15例（28.9%）.3例首次病理检查阴性者在随访中发生未手术侧颈部转移,总的颈隐匿性转移率为34.6%（18/52）,单侧、双侧隐匿性颈转移率分别为28.8%和5.8%.72侧颈清标本共获淋巴结1190枚,其中病理阳性30枚,分布于ⅡA区25枚（83.3%）、Ⅲ区5枚（16.7%）.术侧颈部复发率为5.8%（3/52）.Kaplan-Meier法统计3年累积生存率为84.6%.淋巴结病理阴性和阳性的颈部复发率分别为0（0/34）和16.7%（3/18）,差异有统计学意义（Fisher精确检验,P=0.021）,有无包膜外侵犯的颈部复发率分别为50%（2/4）和2.1%（1/48）,差异有统计学意义（Fisher精确检验,户=0.002）.结论 颈SND（ⅡA、ⅡB和Ⅲ区）治疗cNO声门上型喉癌颈隐匿性转移是可行的,该术式能缩短手术时间、减少并发症且不影响肿瘤治疗效果.

Objective To evaluate the feasibility of routine inclusion of levels Ⅱ and Ⅲ in neck dissection to treat the occult neck metastasis as elective treatment for supraglottic cancer with clinically node negative （cN0）. Methods The results of 52 cN0 patients with supraglottic cancer treated in Tumor Hospital, Harbin Medical University from October 2002 to March 2006 were reviewed retrospectivelly.Results Of the 52 patients with supraglottic cancer and cN0 neck, 32 cases received ipsilateral SND （levels Ⅱ and Ⅲ ） and 20 cases with bilateral SND （ levels Ⅱ and Ⅲ ）. Fifteen （28. 9% ） of 52 patients were found to have occult regional metastasis on pathological examination. Three patients without metastasis in dissected side at pathologic examination showed metastasis in the contralateral undissected neck later on therefore the total occult metastasis rate was 34. 6% （18 of 52）. The unilateral and bilateral neck occult metastases were determined in 15 cases （28. 9% ） and 3 cases （5.8%） respectively. A total of 1190 lymph nodes were harvested in 72 specimens, with 30 positive nodes. The distributions of the 30 positive nodes were as follows： level Ⅱ A 83. 3% （25 nodes）, level Ⅲ 16. 7% （5 nodes）. Three-year regional recurrence rate was 5.8%. The 3-year survival rate was 84. 6% according to Kaplan-Meier in all cN0 patients （ n =52）. Patients with positive neck metastasis and patients with extracapsular spread had higher regional recurrence rates （ P= 0.021 and 0. 002, respectively ）. Conclusions The results support the use of SND（levels Ⅱ and Ⅲ ） in cN0 supraglottic cancer. This procedure will reduce both operating time and morbidity, without compromising the oncologic result.