鼻咽癌放疗后颈部淋巴结残留和复发的分布及处理

Distribution and management of recurrent and persistent lymph node of nasopharyngeal carcinoma after radiotherapy

目的:探讨鼻咽癌患者放疗后颈部淋巴结残留或复发的分布规律并选择合理的颈清扫方式。方法:回顾性分析32例颈淋巴结残留和复发的鼻咽癌患者资料,均行区域或全颈根治性颈清扫术,将颈清扫标本的淋巴结分区行病理学检查,确定颈淋巴结的分布规律,分析残留、复发与初诊时N分期的关系。结果:鼻咽癌放疗后残留和复发的颈淋巴结都是以Ⅱ、Ⅲ、V区为主,其次Ⅳ、Ⅰ区3年、5年总生存率为68.8%、46.8%。结论:初诊N分期越高,淋巴结残留或复发率越高,颈Ⅱ、Ⅲ、V区是鼻咽癌患者放疗后颈部淋巴结残留或复发的主要区域,区域性根治性清扫术或全颈根治性清扫术配合必要的术后局部和浅表的放疗是合适的处理方式。

Objective： To investigate the distribution and management of recurrent and persistent lymph node after radiotherapy for nasopharyngeal carcinoma. Methods： The clinical data of 32 cases of nasopharyngeal carcinoma with recurrent or persistent lymph nodes after radiotherapy were analyzed retrospectively,radical or regional neck dissections were performed for 32 cases. All the lymph nodes of the samples were examined pathologically to identify the distribution,relation between the recurrent and persistent lymph nodes and their initial N staging were analyzed. Results：Recurrent and persistent lymph nodes mainly located in level Ⅱ,Ⅲ and V,next was level Ⅳ and Ⅰ. The 3 and 5years survival rates were 68. 8% and 46. 8% respectively. Conclusion： The patients with higher N stage were susceptible to recur and persist,they were mainly in levelⅡ,Ⅲ and V. The proper operative mode for the patients with residual and recurrent node disease of nasopharyngeal carcinoma after radiotherapy may be the radical or regional neck dissection. As long as choosing patients rationally and give postoperative radiotherapy if necessary.