本文關(guān)鍵詞： 聲門型喉癌 喉前淋巴結(jié) 轉(zhuǎn)移　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:喉前淋巴結(jié)轉(zhuǎn)移作為喉癌預后不良的重要指標被廣泛提出,本文通過回顧性病例分析,探討不同聲門型喉癌喉前淋巴結(jié)轉(zhuǎn)移的規(guī)律,為喉癌規(guī)范手術(shù)提供依據(jù)。方法:對安徽醫(yī)科大學第一附屬醫(yī)院2005年1月至2014年6月收治的92例聲門型喉癌進行回顧性分析,其中男性病人90名,女性病人2人,年齡在42-77歲之間,平均年齡為56.8歲。該92例聲門型喉癌在行不同手術(shù)時,皆常規(guī)行喉前淋巴結(jié)清掃,采集到有效的喉前淋巴組織送檢。比較喉前淋巴結(jié)陰性組及陽性組在腫瘤分期、病理分型、術(shù)后頸部淋巴結(jié)復發(fā)和局部復發(fā)、生存時間之間的差異。結(jié)果:92例病例中喉前淋巴結(jié)陽性者5例,發(fā)生率為5.4%(5/92),5例喉前淋巴結(jié)陽性者均為T3病變。本組早期喉癌(Ⅰ期、Ⅱ期)未見喉前淋巴結(jié)轉(zhuǎn)移,而中晚期喉癌(Ⅲ期、Ⅳ期)喉前淋巴結(jié)發(fā)生轉(zhuǎn)移率較高,為15.2%(5/33),卡方=6.73,P0.01,差異有統(tǒng)計學意義,晚期喉癌(Ⅲ期、Ⅳ期)較早期(Ⅰ期、Ⅱ期)的喉前淋巴結(jié)更容易發(fā)生轉(zhuǎn)移。92例喉鱗狀細胞癌的病理為:高分化41例,中分化40例,低分化11例;伴喉前淋巴結(jié)轉(zhuǎn)移的高分化鱗癌2例,占4.88%(2/41),中、低分化3例,占5.88%(3/51),卡方=0.06,p0.05,差異無統(tǒng)計學意義,故喉前淋巴結(jié)轉(zhuǎn)移與病理分型差異無統(tǒng)計學意義。無喉前淋巴結(jié)轉(zhuǎn)移的喉癌即喉前淋巴結(jié)陰性組術(shù)后頸部發(fā)生頸部淋巴結(jié)復發(fā)者2.30%(2/87),而喉前淋巴結(jié)轉(zhuǎn)移的喉癌即喉前淋巴結(jié)陽性組術(shù)后頸部淋巴結(jié)復發(fā)為40%(2/5),較陰性高,卡方=8.37(p0.01),故喉前淋巴結(jié)轉(zhuǎn)移陽性組術(shù)后發(fā)生頸部淋巴結(jié)復發(fā)較陰性組高,差異有統(tǒng)計學意義。無喉前淋巴結(jié)轉(zhuǎn)移的喉癌即喉前淋巴結(jié)陰性組術(shù)后局部復發(fā)為12.6%(11/87),而喉前淋巴結(jié)轉(zhuǎn)移的喉癌即喉前淋巴結(jié)陽性組術(shù)后局部復發(fā)者占60%(3/5),較前者高,卡方=4.96,(0.01p0.05),故喉前淋巴結(jié)轉(zhuǎn)移陽性組術(shù)后局部復發(fā)較陰性組高,差異有統(tǒng)計學意義。喉前淋巴結(jié)陽性者5例,平均生存時間31.33月,標準誤6.27月,95%CI:19.04月~43.62月,中位生存時間19.00個月。喉前淋巴結(jié)陰性者87例,平均生存時間51.97月,標準誤1.76月,95%CI:48.52月~55.43月,中位生存時間60.00個月,卡方=21.36,p0.01,故喉前淋巴結(jié)陰性組較陽性組生存時間長,差異有統(tǒng)計學意義。結(jié)論:喉前淋巴結(jié)在晚期聲門型喉癌中發(fā)生轉(zhuǎn)移率較高,對于晚期喉癌應常規(guī)行喉前淋巴結(jié)清掃;喉前淋巴結(jié)一旦轉(zhuǎn)移,其頸部和局部復發(fā)的機率增加,預后較差,對于伴發(fā)喉前淋巴結(jié)轉(zhuǎn)移的晚期喉癌應在規(guī)范的手術(shù)基礎上,高度重視術(shù)后的繼續(xù)治療。
[Abstract]:Objective: prelaryngeal lymph node metastasis as an important indicator of poor prognosis of laryngeal carcinoma has been widely proposed. Through retrospective analysis of cases, the regularity of laryngeal lymph node metastasis in different glottic laryngeal carcinoma was discussed. Methods: 92 cases of glottic laryngeal carcinoma treated in the first affiliated Hospital of Anhui Medical University from January 2005 to June 2014 were analyzed retrospectively. There were 90 male patients and 2 female patients, aged between 42 and 77 years, with an average age of 56.8 years. The 92 patients with glottic laryngeal carcinoma underwent routine anterior laryngeal lymph node dissection. Effective prelaryngeal lymphoid tissues were collected and compared between the negative group and the positive group in tumor staging, pathological classification, postoperative cervical lymph node recurrence and local recurrence. Results among 92 cases, 5 cases were positive for prelaryngeal lymph nodes, the incidence was 5.4% (95 / 92). All the 5 cases with positive prelaryngeal lymph nodes were T3 lesions. There was no metastasis of prelaryngeal lymph nodes in early laryngeal carcinoma (stage 鈪，

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