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目的:探讨cN0声门上型喉癌患者颈部淋巴结隐匿性转移规律并选择合理的颈清扫区域。方法:139例cN0声门上型喉癌患者在行喉切除术同时行颈淋巴结清扫术,其中行改良性颈清扫57例,肩胛舌骨肌上淋巴结清扫30例,颈Ⅱ、Ⅲ区淋巴结清扫52例。将所获淋巴结按颈部分区逐一行组织病理学检查,观察其转移规律及临床疗效。结果:139例cN0声门上型喉癌患者中,同期行单侧颈清扫113例,同期行双侧颈清扫26例。139例(165侧)颈清扫标本经病理学检查,颈淋巴结阳性36例(25.9%),首次病理学检查颈淋巴结阴性者在随访中发现未手术侧淋巴结转移6例,总颈淋巴结隐匿性转移率为30.2%(42/139),单侧隐匿性转移率为26.6%(37/139),双侧隐匿性转移率为3.6%(5/139)。165侧颈清扫标本共获得淋巴结3 594枚,平均每侧21.8枚,共获病理阳性淋巴结83枚,其中位于Ⅰ区1枚(1.2%),Ⅱ区65枚(78.3%),Ⅲ区16枚(19.3%),Ⅳ区1枚(1.2%),Ⅴ区0枚。颈部复发率为5.0%(7/139),pN0与pN+的颈部复发率分别为0和16.7%(7/42),差异有统计学意义(P<0.05),总5年生存率为76.3%(106/139)。结论:颈Ⅱ、Ⅲ区是cN0声门上型喉癌颈部淋巴结隐匿性转移的主要区域,择区性(Ⅱ、Ⅲ区)颈淋巴结清扫术治疗cN0声门上型喉癌是合适的。
Objective: To investigate the occult metastasis of cervical lymph nodes in patients with cN0 supraglottic laryngeal cancer and to choose a reasonable neck dissection area. Methods: One hundred and ninety-three patients with cN0 supraglottic laryngeal carcinoma underwent laryngectomy with neck lymph node dissection at the same time. Among them, 57 cases were treated with modified neck dissection, 30 cases with suprascapular hyoid muscle dissection, 52 cases. Lymph nodes were scored by histopathological examination one by one in neck area to observe the metastasis and clinical efficacy. Results: One hundred and ninety-three patients with cN0 supraglottic laryngeal cancer underwent unilateral neck dissection in the same period and 113 patients underwent bilateral neck dissection in the same period. 139 cases (165 sides) of neck dissection specimens were pathologically examined, 36 cases (25.9%) were positive cervical lymph nodes, 6 cases of non-operation side lymph node metastasis and total cervical lymph node metastasis were found in the first pathological examination of negative cervical lymph nodes Rate was 30.2% (42/139), unilateral occult metastasis rate was 26.6% (37/139), bilateral occult metastasis rate was 3.6% (5/139). A total of 3 594 lymph nodes were obtained from 165 neck-neck dissections, with an average of 21.8 on each side. A total of 83 pathologically positive lymph nodes were found, of which 1 (1.2%) in area Ⅰ, 65 (78.3%) in area Ⅱ and 16 (19.3%), one in Ⅳ (1.2%) and one in Ⅴ. The neck recurrence rate was 5.0% (7/139), pN0 and pN + neck recurrence rates were 0 and 16.7% (7/42), the difference was statistically significant (P <0.05), the overall 5-year survival rate was 76.3% (106/139). Conclusion: Cervical Ⅱ and Ⅲ are the main areas of cervical lymph node metastasis in cN0 supraglottic laryngeal carcinoma. The selective (Ⅱ, Ⅲ) cervical lymph node dissection is suitable for cN0 supraglottic cancer.