择区颈部淋巴结清扫对cN0期声门上型喉癌的应用价值

Selective neck lymph nodes dissection for cN0 supraglottic laryngeal cancer

目的:比较择区颈淋巴结清扫术和不予清扫的手术方式对cN0期声门上型喉癌的临床应用价值。方法:103例cN0期声门上型喉癌患者随机分为择区颈淋巴结清扫术组(n=52)和不予清扫组(n=51)两组,分别给予相应的治疗。术后随访3年。生存分析采用Kaplan-Meier曲线和Log-rank检验。结果:52例患者采取择区颈淋巴结清扫术,共清扫淋巴结1126枚,平均21.7枚。共有14例患者检出颈淋巴结转移,占26.9%(14/52)。随着临床分期的提高,cN0患者实际颈淋巴结转移率逐渐增高(χ2=11.451,P=0.010)。转移的152枚淋巴结分布在颈Ⅱ区91枚(59.9%),Ⅲ区42枚(27.6%),Ⅳ区19枚(12.5%)。103例患者3年内共失访9例,随访率为91.3%。3年随访期内共有10例复发。择区清扫组患者3年内复发率为4.2%,不予清扫组为17.4%(χ2=4.321,P=0.038)。择区清扫组1、2年及3年的生存率分别为95.1%、91.4%和89.2%,不予清扫组为93.9%、86.2%和77.5%。择区清扫组术后生存优于不清扫组(χ2=3.316,P=0.014)。结论:①cN0期声门上型喉癌存在一定的隐匿淋巴结转移发生率,并且转移以Ⅱ、Ⅲ区最多见。②采取择区颈淋巴结清扫术既能较大程度的存留颈部的解剖结构,而较不予淋巴结清扫者又具有明显的改善术后生存的治疗优势。

Objective： To compare the selective neck lymph nodes dissection and no lymph nodes cleaning for cN0 supraglottic laryngeal cancer. Methods： 103 patients with cN0 supraglottic laryngeal were randomly divided into selective neck lymph nodes dissection group （n=52）, and no lymph nodes dissection group （n=51）. After 3 years followed up, we used Kaplan-Meier curve and Log-rank test for survival analyzed. Results： A total of 1 126 lymph node dissected form 52 patients in selective lymph nodes neck dissection group. The average number was 21.7. Total of 14 patients detected cervical lymph node metastasis 26.9%（14/52）. With the improvement of clinical stage, cN0 actual cervical lymph node metastasis rate gradually increased （χ2=11.451, P=0.010）. 91 cases （59.9%）, 42 cases （27.6%）, 19 cases （12.5%） of 152 lymph node metastasis distributed in the neck area of district Ⅱ, Ⅲ, Ⅳ, respectively. 9 patients lost in 3 years follow-up （91.3%）. 10 patients recurrence in 3-year follow-up period, 4.2% recurrence rate in selective dissection group vs 17.4% in no dissection group （χ2=4.321, P=0.038）. The 1, 2 and 3 year survival rates were 95.1%, 91.4%, 89.2% and 93.9%, 86.2%, 77.5% in selective dissection group and no dissection group, respectively （χ2=3.316, P=0.014）. Conclusion： ①cN0 supraglottic laryngeal cancer have a certain incidence of occult lymph node metastasis, and the Ⅱand Ⅲ are most common lymph node metastasis areas. ②The selective neck lymph node dissection reserved the anatomy of the neck, and significantly improve the treatment of postoperative survival than no lymph node dissection.