改良性颈廓清术在声门上型喉癌患者中的应用

Clinical application of modified neck lymph node dissection to patients with supraglottic laryngeal carcinoma

目的 :为提高声门上型喉癌患者的生存率和生存质量 ,总结颈廓清术中保留颈内静脉的临床经验。方法 :88例声门上型喉癌患者中 ,在原发灶切除同时 ,共进行 146侧 (双侧 116例 ,单侧 30例 )颈廓清术 ,其中改良颈廓清 (MND)10 6侧 ,根治颈廓清 (RND) 4 0侧。双颈廓清术 5 8例 ,其中同期双颈廓清 32例 ,18例保留双侧颈内静脉 ,14例保留一侧颈内静脉 ;分期双颈廓清 2 6例 ,第一次均为 RND,第二次均为 MND。 30例行一侧颈廓清术 ,术中均保留颈内静脉。结果 :患者 3年生存率同期双颈廓清 81.5 % (2 2 / 2 7) ,分期双颈廓清 6 0 .9% (14/ 2 3) ,一侧颈廓清 75 % (15 / 2 0 )。5年生存率同期双颈廓清 6 1.5 % (16 / 2 6 ) ,分期双颈廓清 40 .9% (9/ 2 2 ) ,一侧颈廓清 70 .6 % (12 / 17)。 MND最大淋巴结直径≤ 3cm,术后复发率 12 .9% (11/ 85 ) ,>3cm者复发率为 47.6 % (10 / 2 1) ,总复发率为 19.8% (2 1/ 10 6 )。 RND术后颈淋巴结复发率为2 2 .5 % (9/ 40 )。结论 :声门上型喉癌常有双颈淋巴结转移 ,需行双颈廓清术 ,并必须保留一侧颈内静脉。在淋巴结小于3cm ,肉眼观与颈内静脉无粘连时保留颈内静脉 ,不增加淋巴结复发率 ,减少并发症 ,并提高生存质量。

Objective:To evaluate the effects of modified neck dissection (MND)preserving jugular vein on patients with supraglottic laryngeal carcinoma,the clinical data of 88 cases were analyzed retrospectively Methods:There were 48 males and 40 females,ranging in age from 37 to 72 years old who were diagnosed supraglottic laryngeal squamous cell carcinoma The clinical stages were T 18,T 2 30,T 3 28,T 4 22,cN 1 38,cN 2 48,cN 3 2;pN 0 11,pN 1 21,pN 2 54 and pN 3 2,respectively Among 146 lateral neck dissections in 88 cases (bilateral 58 cases,one lateral 30 cases),106 were MND,40 being radical neck dissections (RND) Of 106 MND,64 were simultaneously performed bilateral neck dissections (18 cases preserved bilateral jugular veins,14 cases preserved on side jugular veins),52 subsequently bilateral neck dissections(first time was RND ,and the second time was all MND) One side MND was performed in 30 cases,which preserved jugular veins Results:The 3 year survival rate was 81 5%(22/27)in the simultaneous bilateral neck dissection,60 9%(14/23)in the subsequent neck dissection,75 0%(15/20)in the one lateral neck dissection The 5 year survival rate was 61 5%(16/26),40 9%(9/22),70 6%(12/17)respectively The recurrent rate of lymph node postoperative was 12 9%(11/85)in the lymph node less than 3cm in diameter,47 6%(10/21)more than 3cm in diameter The recurrent rate of lymph node was 22 5%(9/40)in the group of RND,19 8%(12/106)in the group of MND Conclusions:Because the neck lymph node metastasis often occurred in supraglottic carcinoma,the bilateral neck dissection is necessary during which one side jugular vein must be preserved Results suggested that if the metastasis lymph node was less than 3cm in diameter and had not adhered to jugular vein,the jugular vein should be preserved,which could lesson complications and get better life quality