下咽癌颈部淋巴结转移特点及相关因素分析

Characteristics and related factors of cervical lymph node metastasis in hypopharyngeal carcinoma

目的探讨下咽癌颈部淋巴结转移特点及相关影响因素。方法回顾性分析我院经病理确诊的91例下咽癌患者的临床资料,转移淋巴结诊断参考术后病理及影像学诊断标准,χ^(2)检验分析淋巴结转移规律及其与临床特征的关系。结果共82例患者有淋巴结转移,原发于环后区的下咽癌淋巴结转移率最高(100%),其次是梨状窝(94.3%)和咽后壁(72.2%)。原发灶T分期对转移率无影响(P=0.275)。同侧颈部Ⅱ、Ⅲ区转移率最高,对侧颈部Ⅱ区转移率最高。咽后壁受侵与Ⅶ区淋巴结转移显著相关(P=0.000),颈段食管受侵与Ⅵb区淋巴结转移显著相关(P=0.000)。颈部淋巴结转移枚数与颈部淋巴结的分布明显相关当仅有1枚淋巴结转移时,仅转移至同侧Ⅱ、Ⅲ区;当有2~3枚淋巴结转移时,同侧Ⅳ、Ⅶ区及对侧Ⅱ区也可发生转移;当转移淋巴结≥4枚时,除上述区域外,还可发生Ⅴ、Ⅵb及Ⅰb区淋巴结转移。结论下咽癌颈部淋巴结转移仍遵循逐站转移规律,最常见的是同侧Ⅱ区和Ⅲ区,其次为同侧Ⅳ区和Ⅶ区,对侧颈部以Ⅱ区最多;不同原发部位的淋巴结转移率各异,颈段食管受侵与Ⅵb区淋巴结转移相关,咽后壁受侵时Ⅶ区转移风险增高。

Objective To investigate the characteristics and related influencing factors of cervical lymph node metastasis in hypopharyngeal cancer.Methods The clinical data of 91 patients with hypopharyngeal carcinoma diagnosed by pathology in our hospital were retrospectively analyzed.The diagnosis of metastatic lymph nodes was based on the postoperative pathological and imaging diagnostic criteria.Theχ^(2) test was used to analyze the regularity of lymph node metastasis and its relationship with clinical characteristics.Results A total of 82 patients suffered lymph node metastasis.The lymph node metastatic rate of hypopharyngeal carcinoma originating in the postcricoid area was the highest(100%),followed by the piriform sinus(94.3%)and the posterior pharyngeal wall(72.2%).T stage of primary lesion had no effect on the metastasis rate(P=0.275).The metastatic rate in the ipsilateral neck regionⅡandⅢwas the highest,while that in the contralateral neck regionⅡwas the highest.The invasion of the posterior pharyngeal wall was significantly correlated with the lymph node metastasis in regionⅦ(P=0.000),and the invasion of cervical esophagus was significantly correlated with the lymph node metastasis in regionⅥb(P=0.000).There was a significant correlation between the number of cervical lymph node metastases and the distribution of cervical lymph nodes;when there was only 1 lymph node metastasis,it only metastasized to the ipsilateral regionⅡand regionⅢ;when there were 2 to 3 lymph node metastases,lymph node metastasis in the ipsilateral regionⅣ,regionⅦand contralateral regionⅡcould also occur;when there were more than 4 metastatic lymph nodes,besides the above-mentioned regions,lymph node metastasis in region V,regionⅥb and regionⅠb could also occur.Conclusion Cervical lymph node metastasis of hypopharyngeal carcinoma still follows a regularity of station-by-station metastasis,and the most common are ipsilateral regionⅡand regionⅢ,followed by ipsilateral regionⅣand regionⅦ,and the regionⅡis the most common in the contralateral neck.The lymph node metastasis rate varies in different primary sites.The lymph node metastasis in regionⅥb is related to the invasion of cervical esophagus,and the risk of metastasis in regionⅦis increased when the posterior pharyngeal wall is invaded.