2种不同术式治疗咽癌放疗后颈淋巴结残留效果

Effect of two different surgical treatments on residual of neck lymph node after radiotherapy in nasopharyngeal carcinoma

目的探讨2种不同术式治疗咽癌放疗后颈淋巴结残留远期效果。方法对43例鼻咽癌放疗后颈淋巴结残留的患者,据淋巴结大小及是否单发分为2组,孤立性且直径≤3cm者22例为A组,行根治性颈淋巴结清扫术;其余21例均进入B组,行功能性颈淋巴结扫除术。结果术后病理显示,所有标本均为转移鳞状细胞癌,其中低分化31例,中分化7例,高分化5例,包膜外侵袭者30例,未见侵袭者13例。术后仅A组发生1例皮瓣部分坏死,2组并发症发生率比较无显著性差异(P>0.05)。所有患者随访满5 a,2组5 a死亡率无显著性差异。结论根治性和功能性颈淋巴结扫除术等挽救性手术,可控制或延缓病情发展,提高生活质量,延长患者生存时间;术后合理放化疗可有效提高5 a生存率。

Objective It is to approach the long term effect of two different surgical procedures on residual of neck lymph node after radiotherapy in nasopharyngeal cancer. Methods 43 patients with residual of neck lymph node after radiotherapy in patients with nasopharyngeal cancer were divided into two groups according to whether the single and lymph node size,the lymph of diameter≤3 cm and isolated in 22 cases as in group A underwent radical neck dissection surgery;remaining 21 cases were included in group B underwent functional neck surgery to remove lymph nodes. Results Postoperative pathology showed that all specimens for the transfer of squamous cell carcinoma,which 31 cases with low differentiation,7 cases with moderately differentiated and 5 cases with high differentiation;30 cases of capsule invasion,not seen struck 13 cases. Group A only oc-curred in 1 case postoperatively part flap necrosis,there was no significant difference in complication rate between two groups （ P〉0. 05）. All patients were followed up for 5 years,there was no significant difference in 5 year mortality rate between both groups（P〉0. 05）. Conclusion Radical and functional analysis sweep save operation,to control or delay the disease develop-ment,improve the quality of life and prolong survival time,but reasonable postoperative radiation and chemotherapy,can ef-fectively improve the 5 -year survival rate.