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临床有颈淋巴结转移者为颈部治疗的指征,但大涎腺癌可能有隐匿颈淋巴结转移者颈部选择性治疗的指征不明确。为此回顾1939～1982年所治疗的474例大涎腺癌,以期推荐适当的治疗方法。治疗方法主要是手术切除,术后选择性并用放疗。临床有淋巴结转移者67例(14%)做了治疗性颈廓清,经病理证实均有淋巴结受累,术后16例作了放疗。407例临床淋巴结阴性者,90例(22%)做了选择性颈廓清(END),有隐匿性病灶者38%,有10例隐匿性淋巴结转移发生在腮腺及其周围,3例发生于颌下腺。隐匿性转移发生率:颌下腺为21
Cervical lymph node metastases are clinical indications for neck treatment, but indications for selective neck treatment in patients with metastatic adenocarcinoma who may have cervical lymph node metastases are unclear. To this end, we reviewed 474 cases of bullous adenocarcinoma treated from 1939 to 1982 in order to recommend appropriate treatments. The treatment is mainly surgical resection, and selective radiotherapy is used after surgery. 67 patients (14%) with clinical lymph node metastases had a therapeutic neck dissection. Lymph node involvement was confirmed by pathology. Radiotherapy was performed in 16 patients after surgery. Of the 407 patients with negative clinical lymph nodes, selective neck dissection (END) was performed in 90 (22%) patients. Occult lesions were found in 38% of patients. Occult lymph node metastasis occurred in and around the parotid gland in 10 cases, and submandibular gland in 3 cases. . Occurrence rate of occult metastases: 21 in the submandibular gland