喉及下咽鳞癌颈淋巴结隐匿性转移灶的研究

The study on the occult metastases to cervical lymph node in squamous cell carcinoma of the larynx and hypopharynx

目的 :进一步探讨喉及下咽鳞癌颈淋巴结转移规律 ,为喉及下咽鳞癌颈淋巴结清扫术提供理论依据。方法 :收集 1997年 5月～ 1999年 7月 4 0例临床颈淋巴结阴性 ( c N0 )的喉及下咽鳞癌患者改良根治性颈清扫术所得标本 ,且术前未经任何治疗者为研究病例。对颈清扫淋巴结 (共 2 2 19枚 )进行常规 HE及免疫组化法检查。全部病例随访 1年以上。结果 :喉及下咽鳞癌出现颈淋巴结转移 14例 ( 3 5 % ) ,共 3 1枚 ( 1.4 % )淋巴结 ,其中声门上癌 6例 ( 6/2 0 ) ,跨声门癌 1例 ( 1/1) ,下咽癌 7例 ( 7/10 )。 9例声门癌无颈淋巴结转移。颈淋巴结转移均位于颈 、 区。结论 :喉及下咽鳞癌颈淋巴结转移多发生于患侧颈 、 区 (局限于声门区喉癌除外 )。对于 T2 ～ T4 声门上癌、跨声门癌及下咽癌的 c N0 患者 ,根据其可能发生颈淋巴结隐匿性转移的高危险性 ,建议行患侧或双侧颈 及 区淋巴结清扫术。

Objective:To study the metastastic regularity of cervical lymph node in squamous cell carcinoma of the larynx and hypopharynx, which will provide some theoretical basis for surgeon to use selective neck dissection (SND) in some patients with carcinoma above.Method:Sixty nine originally cN 0 staged neck dissection specimens from 40 patients were evaluated using mutipl level sectioning in 4 μm intervals, which were respectively processed by H&E staining and immunostaining with an antibody to cytokeratin (CK AE3).These patients weren′t given any treatment (radiotherapy or chemotherapy or surgery in neck) before surgery.All cases had been followed up 1 year or more.Result:The examination of lymph nodes from 40 patients revealed 31 ( 0.59 % 31/2219) occult metastases in 14 (35% 14/40) patients.Among them,six patients with supraglottic cancer, 1 patient with transglottic cancer and 7 patients with hypopharyngeal cancer.There were no occult metastases to cervical lymph node among 9 patients with glottic cancer.All occult metastases mainly located in ipsilateral level Ⅱ and/or level Ⅲ.Occult metastases weren′t found in nodes from level Ⅰ, level Ⅳ and level Ⅴ.Conclusion:The study further prove that metastases to cervical lymph node mainly occur in the ipsilateral level Ⅱ and level Ⅲ among patients with carcinoma of the larynx and hypopharynx.According to the risks of occurring occult metastases to cervical lymph node, we suggest applying to ipsilateral or bilateral SND (level Ⅱ and level Ⅲ be dissected) among patients with carcinoma of the larynx and hypopharynx which staged T 2~T 4 N 0M 0 clinically.