【摘要】：目的 總結(jié)頸部淋巴結(jié)的處理方式對(duì)cN0型聲門(mén)上型喉癌預(yù)后的影響,探討cN0型聲門(mén)上型喉癌行選擇性頸部Ⅱ、Ⅲ和(或)Ⅳ區(qū)淋巴結(jié)清掃的意義。 方法 回顧性分析2003年1月至2007年5月于鄭州大學(xué)第一附屬醫(yī)院確診為cN0型聲門(mén)上型喉鱗狀細(xì)胞癌且有完整病歷資料的患者共83例,原發(fā)灶均經(jīng)手術(shù)切除,隨訪5年以上或至患者死亡。分析擇區(qū)性頸部淋巴結(jié)清掃術(shù)與其他方法(放射治療、綜合治療、隨診觀察)處理頸部淋巴結(jié)后,患者生存率有無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.cN0型聲門(mén)上型喉癌頸部淋巴結(jié)轉(zhuǎn)移率為30.77%,且隨著T分期的增加,頸淋巴結(jié)的轉(zhuǎn)移率也逐漸增高。低分期(T1、T2)者頸淋巴結(jié)轉(zhuǎn)移率明顯低于高分期(T3、T4)者(P0.05)。 2.采取術(shù)中、術(shù)后干預(yù)措施(頸清掃、放療以及綜合治療)患者的頸淋巴結(jié)復(fù)發(fā)率分別為20.96%、25.00%、20.00%；無(wú)術(shù)中、術(shù)后干預(yù)措施(臨床觀察)患者頸淋巴結(jié)復(fù)發(fā)率為46.43%,采取干預(yù)措施患者的頸部淋巴結(jié)復(fù)發(fā)率明顯低于未采取干預(yù)措施患者(P0.05)。 3.清掃組與放療組、綜合組5年生存率分別為79.30%、75.00%、80.00%,差異均無(wú)顯著性(P0.05),觀察組5年生存率為57.10%,與清掃組差異有顯著性(P0.05)。 結(jié)論 1.cNo型聲門(mén)上型喉癌患者有1/3左右有頸部淋巴結(jié)轉(zhuǎn)移,且隨著T分期的增加,頸淋巴結(jié)的轉(zhuǎn)移率也逐漸增高。 2.對(duì)cNo聲門(mén)上型喉癌患者頸部淋巴結(jié)行選擇性頸清掃可明顯降低患者頸部復(fù)發(fā)率,提高5年生存率。 3.對(duì)cNo聲門(mén)上型喉癌患者,切除原發(fā)病灶同時(shí)行選擇性頸清掃術(shù)的療效與術(shù)后行頸部放射治療與綜合治療的療效相當(dāng),均優(yōu)于切除原發(fā)病灶后臨床觀察患者。
[Abstract]:Objective to summarize the effect of cervical lymph node management on the prognosis of cN0 type supraglottic laryngeal carcinoma and to explore the significance of selective neck dissection in cN0 type supraglottic laryngeal carcinoma. Methods from January 2003 to May 2007, 83 patients with cN0 type supraglottic laryngeal squamous cell carcinoma diagnosed in the first affiliated Hospital of Zhengzhou University were retrospectively analyzed. Follow-up for more than 5 years or until the patient died. The survival rate of patients treated with selective cervical lymph node dissection and other methods (radiotherapy, combined therapy, follow-up observation) was analyzed. Results the cervical lymph node metastasis rate of 1.cN0 type supraglottic laryngeal carcinoma was 30.777.The metastasis rate of cervical lymph node increased with the increase of T stage. The rate of cervical lymph node metastasis in patients with low staging (T _ 1 / T _ 2) was significantly lower than that in patients with high grade (T _ 3 / T _ 4) (P0.05). The recurrence rate of cervical lymph nodes in patients with intraoperative and postoperative intervention (neck dissection, radiotherapy and combined therapy) was 20.96%, 25.00% and 20.00%, respectively. The recurrence rate of cervical lymph nodes was 46.43 in patients with intervention (clinical observation). The recurrence rate of cervical lymph nodes in patients with intervention was significantly lower than that in patients without intervention (P0.05). The 5-year survival rate in the sweeping group and radiotherapy group was 79.30% and 75.00%, respectively, with no significant difference (P0.05). The 5-year survival rate in the observation group was 57.10%, which was significantly higher than that in the sweeping group (P0.05). Conclusion 1 / 3 of the patients with 1.cNo type supraglottic laryngeal carcinoma have cervical lymph node metastasis, and with the increase of T stage, the cervical lymph node metastasis rate increases gradually. 2. Selective neck dissection in patients with cNo supraglottic laryngeal carcinoma could significantly reduce the cervical recurrence rate and increase the 5 year survival rate. In patients with cNo supraglottic laryngeal carcinoma, the curative effect of resection of primary lesions and selective neck dissection was similar to that of postoperative cervical radiotherapy and comprehensive treatment, and was superior to that of clinical observation after resection of primary lesions.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R739.65

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