颈侧清扫术与颈根治性清扫术治疗声门上型喉癌的疗效对比

Lateral neck dissection vs radical neck dissection in the management of supraglottic carcinoma with pathologically negative nodes

目的 对比颈侧清扫术 (lateralneckdissection ,LND)与根治性或改良根治性颈清扫术(radicalneckdissection ,RND)在治疗喉癌声门上型颈淋巴结病理阴性 (pN0 )患者中的效果。方法回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科治疗的喉鳞状细胞癌声门上型pN0患者。对照的两组患者分别是 39例 1980年 3月～ 1996年 12月之间采用根治性或改良根治性颈清扫术治疗的患者 (RND组 ) ;4 5例 1997年 1月～ 2 0 0 1年 12月之间采用颈侧清扫术患者 (LND组 )。结果 LND组 5年颈部淋巴结转移率为 2 3% ,RND组 5年颈部淋巴结转移率 0 ,无统计学意义 (P =0 347) ;两组的 5年生存率分别是 97%和 94 % ,无统计学意义 (P =0 6 13)。但是 ,LND组与颈清扫术有关的并发症显著的低于RND组 (6 7%和 38 5 % )。此外 ,LND组较RND组缩短了 11d平均外科住院时间 (2 8d和 39d)。结论 与根治性或改良性颈清扫术相比 ,采用颈侧清扫术并不影响pN0喉癌声门上型患者的肿瘤治疗效果 ,但却减少了损伤 ,降低了并发症 ,缩短了住院时间。

Objective To compare the effectiveness of lateral neck dissection (LND) with radical or modified radical neck dissection (RND) for the management of supraglottic carcinoma with pathologically negative nodes (pN0). Methods Two treatment groups with pN0 supraglottic carcinoma were retrospectively compared: 39 patients who were treated with RND between March of 1980 and December of 1996, and 54 patients who were treated with LND between January 1997 and December 2001. Results The neck recurrent for LND population was 2.3%, which was not statistically different from the neck recurrent in the RND population (0.0%). Also, the 5-year survival rates were no statistic difference between LND and RND groups (97% vs 94%). Complications and period of hospitalization were both decreased in LND group comparison of RND group (6.7% vs 38.5%; 28 days vs 39 days). Conclusion Comparing to the radical or modified neck dissection, the LND offers less invasive surgery and less morbidity without oncologic compromise for patients with pN0 supraglottic carcinoma.