鼻咽癌患者放疗后颈部淋巴结残留和复发的手术疗效及方式选择(附120例分析)

Surgical treatment options of neck dissection for recurrent and persistent lymph nodes of nasopharyngeal carcinoma patients after radiotherapy:Analysis of 120 cases

目的探讨鼻咽癌患者放疗后颈部淋巴结残留和复发的最有效的手术方式。方法回顾性分析120例颈淋巴结残留和复发的鼻咽癌患者资料,分析残留和复发的淋巴结位置及各位置间相互关系,比较全颈清扫、改良性、择区性颈清扫术和颈淋巴结切除术4种手术方式的生存率、复发率。结果鼻咽癌放疗后残留和复发颈淋巴结都是以Ⅱ区为主(80%)。102例鼻咽癌患者5年累积生存率43.61%,颈淋巴结复发率为20.83%。全颈清扫术、改良性颈清扫术、择区性颈清扫术和颈部淋巴结切除术组患者5年累积生存率分别为38.3%、58.7%、36.6%和43.1%,差异无统计学意义(Log-rankχ2=1.0,P=0.813 3)。结论广泛切除术适应于鼻咽癌患者放疗后残留和复发颈淋巴结累及1个区以上和/或直径较大和/或固定者,其余则可采用选择性颈清扫术。

Objective To investigate the best surgical mode for the patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy. Methods The clinical data of 120 patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively. The levels of involved lymph nodes and the relationship among the levels were analyzed; the survival rate and recurrent rate of the surgical modes including radical neck dissection （RND）, modified radical neck dissection （MRND）, selective neck dissection （SND）, and lymph node resection （LNR） were analyzed. Results The recurrent and persistent lymph nodes mainly located in level Ⅱ （80%, respectively）. Patients with lymph nodes involved in level Ⅲ and Ⅳ usually, had other levels involved simultaneously. However, the lymph nodes in level Ⅱ and Ⅴ were mainly isolated. The 5-year accumulated survival rate and cervical lymph node r.eeurrent rate of the whole group were 43.61% and 20. 830/oo respectively. The 5-year survival rates of RND, MRND, SND, and LMR groups were 38.3%, 58.7%, 36.6% and 43.1%, respectively; the differences were insignificant （Log-rank x^2 = 1.0, P = 0. 813 3）. Conclusion The extensive surgery is recommended when the recurrent and persistent lymph nodes are more than one level in- volved or very large or immovable, otherwise, the SND should be performed.