喉癌和下咽癌颈淋巴结转移临床对比分析

The clinical analysis of cervical lymph node metastases from squamous cell carcinoma of the larynx and hypopharynx treated with total laryngectomy

目的 :探讨喉癌、下咽癌患者颈淋巴结转移的特点和分布规律。方法 :对全喉切除术同期及复发后第 1次行颈淋巴结清扫的 12 9例喉癌、下咽癌患者的临床资料进行回顾性对比分析 ,研究不同类型的喉癌、下咽癌患者颈淋巴结的转移情况。结果 :声门上型喉癌、下咽癌患者易发生早期淋巴结转移 ;下咽癌患者的转移淋巴结融合率高 ,颈静脉下区出现阳性淋巴结的比率高 ;声门上型喉癌、下咽癌患者原发病灶分化差的比率相对偏高 ;同期与复发后行颈淋巴结清扫的患者原发病灶分期差异无显著性意义。结论 :对T2 期及以上的声门上型喉癌及下咽癌患者 ,尤其当细胞分化比较差时 ,即使颈淋巴结阳性体征不明显亦应积极考虑颈淋巴结清扫问题 。

Objective:To detect the distribution and characteristics of lymph nodes metastasis in patients of laryngeal and hypopharyngeal cancer.Method:A retrospective review of 129 patients who had radical neck dissection, including first recurrence in cervical lymph nodes after laryngectomy, was performed to analyze the cervical lymph node metastases of different types of laryngeal and hypopharyngeal cancer treated by total laryngectomy.Result:The patients of the hypopharyngeal and supraglottic cancer had a tendency of cervical lymph nodes metastasis in their early stage. The rate of the fusional lymph nodes was high in hypopharyngeal cancer, and so as to the rate of the positive lymph nodes in their level Ⅳ.In our study the percentage of the poor differentiated squamous cell carcinoma was relatively high in hypopharyngeal and supraglottic cancer than in glottic cancer. And there was no statistical difference in stages of the primary tumour between groups of neck dissection with laryngectomy simultaneously and of first recurrence in lymph nodes after laryngectomy.Conclusion:The latent lymph nodes metastasis and preventive neck dissection should be considered in patients of hypopharyngeal and supraglottic cancer in or above stages of T 2, especially in patients with poor differentiated squamous cell carcinoma, though the sign of positive lymph nodes was not evident.