淋巴结切除在颈动脉体瘤手术治疗中的作用

The advantage of lymph node removal in surgical treatment of the carotid body tumor

目的：总结手术治疗良恶性颈动脉体瘤的经验,探讨颈动脉体瘤手术中瘤体周围淋巴结切除的临床价值。方法回顾性分析中国医学科学院肿瘤医院1976年1月—2013年10月手术治疗的106例良、恶性颈动脉体瘤患者的临床资料。其中男37例,女69例；年龄7~67岁；肿瘤发生于左侧62例,右侧42例,双侧 2例。术前诊断为颈动脉体瘤86例,另20例术前诊断为颈部肿物待查；无一例术前诊断为恶性颈动脉体瘤。根据术中是否行瘤体周围淋巴结切除活检分为淋巴结切除组（54例）和未切除组（52例）,随访其术后生存及复发情况。采用 Kaplan-Meier 生存分析法计算并比较两组患者术后无复发生存率。结果106例患者中,98例获随访,8例失访,其中淋巴结切除组失访5例,未切除组失访例3例。随访时间7个月~38年,中位随访时间 8年。淋巴结切除组术后无复发生存率为97.0%,高于淋巴结未切除组的73.7%（χ^2=9.938, P 〈0.01）；明确诊断良恶性者术后无复发生存率93.4%,高于未行淋巴结切除从而诊断恶性证据不足者的14.0%（χ^2=45.054, P 〈0.01）。淋巴结切除组神经损伤发生率为35.2%（19/54）,低于淋巴结未切除组的55.8%（29/52）,差异有统计学意义（χ^2=4.530, P 〈0.05）。结论颈动脉体瘤手术中,瘤体周围淋巴结切除活检有助于明确诊断、指导治疗,从而提高颈动脉体瘤手术治疗后无复发生存率；同时,还有利于暴露术野,降低神经损伤发生率。

Objective To summarize the experience of surgical treatment for the benign and malignant carotid body tumor, and study the clinical value of lymph node removal around the tumor in the surgery. Methods A retrospective study was performed to analyze the clinical data of 106 patients with benign or malignant carotid body tumor who accepted surgery treatment in Chinese Academy of Medical Science Cancer Hospital from January 1976 to October 2013. In this study, there were 37 males and 69 female patients,aged from 7 to 67 years. Tumor in the left side of the 62 patients, 42 patients occurred in the right, on both sides in 2 patients. The 86 patients were diagnosed carotid body tumor in the preoperative. Another 20 patients were preoperative diagnosis of cervical neoplasm, looking forward to pathological diagnosis. No patients were diagnosed malignant carotid body tumor in the preoparative. Patients were divided into two groups according to whether or not removal of lymph node around the tumor, lymph node removal group（n = 54） and no lymph node removal group（ n = 52）, then followed up their survival and relapse situation. The Kaplan-Meier survival analysis was used to calculate the relapse-free survival rate and making a comparision of different groups. Results Among 106 patients in this group, 98 cases were followed up completely and 8 cases failed to be followed up（5 cases of lymph node removal and 3 cases of non-lymph node removal）, the follow-up period was from 7 months to 38 years and the median follow-up was 8 years. The lymph node removal group had a 97. 0% higher rate of relapse-free survival than the group without lymph node removal whose rate was 73. 7% （χ^2 = 9. 938, P 〈 0. 01）. Besides,the patients who had been diagnosed benign or malignant with the rate 93. 4% of relapse-free survival, which had a higher rate than the other patients who were considered benign by pathology diagnosis because no evidence to be diagnosed malignant without lymph nodes removal whose rate of relapse-free survival was 14. 0% （ χ^2 =45. 054, P 〈 0. 01）. The group of lymph node removal had a lower rate （35. 2% , 19 / 54） of nerve injury than the other group（at the rate of 55. 8% , 29 / 52） without lymph node removal,the difference between groups was statistically significant （ χ^2 = 4. 530, P 〈 0. 05）. Conclusions Removal of the lymph nodes around the tumor in surgical treatment of the carotid body tumor can help to diagnose accurately and guide treatment, then increase the rate of relapse-free survival after surgery. Furthermore, it can also help to expose the operative field and reduce the rate of nerve injury.