声门上区癌颈淋巴结转移的临床及病理探讨

Clinicopathological Study on Cervical Lymph Node Metastasis of Supraglottic Carcinoma

目的 :通过 10 0例声门上区癌的临床病理研究 ,分析其原发癌和颈淋巴结转移的关系。方法 :临床颈淋巴结阴性的 6 3例中 30例只切除原发癌 ,术后 14例因颈淋巴结肿大而行治疗性颈清术 ,另 33例在切除原发癌的同时 ,行选择性上颈清除术 ;临床颈淋巴结阳性的 37例 ,均行治疗性颈清术。结果 :1) 10 0例颈淋巴结转移率为 5 1%(5 1/10 0 )。 2 ) 5 1例颈淋巴结转移癌中 ,有 35例转移癌侵至淋巴结包膜外 ,其中 2 1例治疗失败。 3) 10 0例中 ,原发癌部位不同 ,其颈淋巴结转移率也不同 :杓会皱襞区癌和杓间区癌为 77 8% ,会厌室带区癌、室带区癌、室带喉室区癌为 5 0 8% ,会厌区癌为 43%。 4)原发癌扩展至喉外者颈淋巴结转移率为 88 9%。结论 :由于声门上区癌淋巴结转移率较高 ,建议在切除原发癌 (N0 )时宜同时合并选择性颈清术。

Objective: The relationship between the primary cancer and cervical lymph node metastasis in 100 cases of supraglottic carcinoma was studied clinicopathologically Methods: In 30 out of 63 cases of node-negative supraglottic carcinoma, simple excision of the primary tumor was performed In the 14 postoperative cases, therapeutic resection of cervical nodes was performed because of enlarged lymph nodes In another 33 cases, at time of removal of the primary tumor, selective resection of superior deep lymph nodes of the internal jugular vein was done Thirty-seven patients with clinically positive lymph nodes underwent therapeutic resection of cervical lymph nodes Results: 1) The lymph node metastatic rate of the entire series was 51%(51/100) 2) Among 51 cases of lymph node metastatic cancer, 35 cases had invasion beyond the capsule of lymph nodes ,and 21 cases treated with failure 3) In all these cases, different sites of the primary cancer had different lymph node metastatic rates 4) The cervical lymph node metastatic rate of the supraglottic cancer with extralaryngeal invasion was 88 9% Conclusion: The cervical lymph node metastatic rate of supraglottic cancer is very high and the prognosis of cases in lymph node capsule invasion is poor Site of primary tumor, justifies estimation of cervical lymph node metastasis