不同声门型喉癌喉前淋巴结转移研究

Study on prelaryngeal node metastases in different glottic carcinoma

目的探讨不同声门型喉癌喉前淋巴结转移规律,为喉癌规范手术提供依据。方法92例声门型喉癌在行不同手术时,皆常规行喉前淋巴结清扫并送检。比较喉前淋巴结阴性组及阳性组在肿瘤分期、病理分型、术后颈部淋巴结复发和局部复发、生存时间之间的差异。结果92例喉前淋巴结阳性者5例,阳性率5.4%(5/92),晚期喉癌(III期、IV期)较早期(I期、II期)喉前淋巴结更容易发生转移,差异有统计学意义。喉前淋巴结转移与病理分型差异无统计学意义;喉前淋巴结转移阳性组术后发生颈部淋巴结转移较阴性组高,差异有统计学意义;喉前淋巴结转移阳性组术后局部复发较阴性组高,差异有统计学意义。喉前淋巴结阴性组较阳性组生存时间长,差异有统计学意义。结论喉前淋巴结在晚期声门型喉癌中发生转移率较高,手术时应常规清扫;喉前淋巴结一旦转移,其颈部和局部复发几率增加,预后较差,提示进一步的后续规范治疗的重要性。

OBJECTIVE To study the rules of prelaryngeal node metastases in different glottic carcinoma in order to provide basic information for standard operation the laryngeal cancer.METHODS Prelaryngeal lymph node dissection was performed in 92 cases with glottic carcinoma.The differences of tumor staging,pathological typing,postoperative cervical or local recurrence,survival time were compared and analyzed between the groups of positive and negative prelaryngeal node.RESULTS There were 5 cases（5.4%） with positive prelaryngeal node among 92 cases.The prelaryngeal nodes in advanced laryngeal cancer（III,IV stage） was more easily to be metastasized than those in early stages（I,II）,the difference was statistically significant.There was no significant difference in prelaryngeal node metastasis among different pathological types.The local and regional recurrence rates in positive prelaryngeal lymph node metastasis group were higher than those in the negative group,the difference was statistically significant.Compared with positive group,the negative group had a longer survival time,and the difference was statistically significant.CONCLUSION The rate of prelaryngeal node metastases is high in patients with advanced glottic carcinoma.Once the prelaryngeal node metastases occur,the recurrence rate will be increased and the prognosis is poor,that suggest the importance of standardized treatment.