头颈鳞癌颈部转移淋巴结包绕颈动脉的外科处理策略

Surgical management strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma

目的探讨头颈鳞状细胞癌的颈部转移淋巴结包绕颈动脉的手术干预策略。方法回顾性分析2019年6月至2023年12月,南京医科大学附属明基医院耳鼻咽喉头颈外科收治的62例病变包绕颈动脉的晚期头颈肿瘤患者资料,其中原发灶未见复发或原发灶不明的颈部淋巴结转移性鳞状细胞癌患者9例,均为男性,年龄48~79岁。患者的体力状态(performance status,PS)评分均在2级及以下,影像学诊断颈总动脉和/或颈内动脉均被肿瘤包绕≥270°。本组患者均予覆膜支架动脉内置入+颈部淋巴结转移癌根治性切除术。总结覆膜支架动脉内置入的成功率和并发症、手术相关并发症、局部复发率、患者生存质量及总生存率。患者生存质量采用配对秩和检验进行对比分析,总生存率采用Kaplan-Meier进行分析。结果覆膜支架置入成功率100%,无支架置入并发症。手术R0切除8例,R1切除1例。术后患者生存质量提高,在“疼痛”“情绪”“焦虑”方面改善的差异有统计学意义(Z值分别为-2.236、-2.460、-2.200,P值均<0.05)。随访1~18个月,中位随访时间为7个月;1例患者失访,3例出现局部复发,发生率为37.5%(3/8)。患者的12个月生存率为59.9%。结论覆膜支架动脉内置入+颈部淋巴结转移癌根治性切除术是一种治疗颈部淋巴结转移癌的有效方式。

ObjectiveTo explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma.MethodsA total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery,the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed,of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males,aged from 48 to 79 years old,with≤level 2 of Eastern Cooperative Oncology Group-Performance Status(ECOG-PS).Radiographically common carotid artery(CCA)and/or internal carotid artery(ICA)were surrounded by≥270°with tumor.All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes.The success rate,complications,surgery-related complications,local recurrence rate,quality of life(QOL)and overall survival(OS)were analyzed.The QOL of patients was compared by paired rank sum test,and P<0.05 indicated statistically significant difference.The OS was analyzed by Kaplan-Meier.ResultsThe success rate of stent implantation was 100%,with no implantation-related complications.R0 resection was performed in 8 cases and R1 resection in 1 case.The QOL of patients after surgery was improved,and the improvements in"pain","mood"and"anxiety"were statistically significant(Z values were-2.236,-2.460 and-2.200,respectively,and all P values were<0.05).Follow-up was 1-18 months,with a median of 7 months,and 1 case was lost to follow-up.Local recurrence occurred in 3 patients with an incidence of 37.5%(3/8).OS was 59.9%at 12 months after surgery.ConclusionImplantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.