颈分区性清扫术治疗头颈部鳞状细胞癌的远期疗效

Efficacy of selective neck dissection:a review of 123 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of head and neck

目的 研究颈分区性清扫术在头颈部鳞状细胞癌 (简称鳞癌 )治疗中的效果。方法 回顾性分析 1997年 1月～ 2 0 0 1年 12月在中国医学科学院肿瘤医院接受分区性清扫术的头颈部鳞癌患者 12 3例 ,其中喉癌 77例、口腔癌 2 9例、口咽癌 2例、下咽癌 15例。分区性清扫术后发现淋巴结病理阴性 (pN0 ) 99例 ,淋巴结病理阳性 (pN + ) 2 4例。随访时间中位数为 2 5个月。结果 10 1例cN0患者行分区性清扫术后发现pN + 14例 ( 13 9% ) ;2 2例cN +患者行分区性清扫术后发现pN + 10例( 4 5 5 % )。 15 7侧分区性清扫标本中共发现 5 2枚阳性淋巴结 ,其在颈部的分布如下 :Ⅰ区 2 5 % ,Ⅱ区4 8% ,Ⅲ区 2 5 % ,Ⅳ区 2 %。根据Kaplan Meier方法计算 5年颈部复发率 ,pN0患者为 5 87% ( 95 %可信区间 0 8% ,10 9% ) ,pN +患者为 9 2 % ( 95 %可信区间 0 0 % ,2 1 5 % )。结论 颈分区性清扫术从微创观念出发 ,只要选择恰当 ,对于头颈部鳞癌患者可以取得与传统颈清扫术相当的效果。更重要的是保留了患者的功能和外观 。

Objective To evaluate the efficacy of selective neck dissection (SND) in elective and therapeutic treatment of the neck in squamous cell carcinoma of head and neck Methods A retrospective review was undertaken of 123 patients undergoing 157 SNDs as a part of initial therapy for squamous cell carcinoma of head and neck from Janunary 1997 to September 2001 at this institute The primary site included larynx( n =77), oral cavity( n =29), oropharynx( n =2), and hypopharynx( n =15) Lymph nodes were pathologically negative (pN0) in 99 and positive (pN+) in 24 patients Peri operative radiotherapy was given to 30 3% of pN0 and 50 0% of pN+ patients. The median follow up interval was 25 months Results 101 patients received elective neck dissection, 14 of them (13 9%) found to be pN+, while 22 patients received therapeutic neck dissection, 10 of them (45 5%) found to be pN+ A total of 52 positive nodes were found in 157 SNDs The distribution of the positive nodes were as follows: Level Ⅰ 25%; Level Ⅱ 48%; Level Ⅲ 25%; Level Ⅳ 2% The 5 year regional recurrence rates estimated according to Kaplan Meier were 5 87% (95%CI: 0 8%, 10 9%) for the pN0 and 9 2% (95%CI: 0 0%, 21 5%) for pN+ patients Conclusion The SND, when carefully indicated, a contribution to the concept of less invasive surgery, offers functional and esthetic advantages without oncologic compromise