声门上喉癌双侧颈淋巴结转移的临床病理研究

目的 :探讨声门上喉癌双侧颈淋巴结转移的临床病理特点。方法 :收集声门上喉癌伴颈淋巴结转移者 60例 ,其中单侧颈淋巴结转移和双侧颈淋巴结转移各 3 0例 ,根据肿瘤主体部位、肿瘤大小、表面形态、临床TNM分期、累及对侧半喉的程度、肿瘤分化程度、肿瘤边缘生长方式及会厌前间隙受累程度进行对比观察。结果 :单侧转移组和双侧转移组在 N0 期与 N2 期差异有显著性意义 ( χ2 =19.5 2 ,P<0 .0 5 ) ;双侧转移组中肿瘤累及对侧半喉中、重度比率明显高于单侧转移组 ( P<0 .0 5 ) ;临床 T4 期时 ,双侧转移组低分化者占 63 .6% ,高于单侧转移组的 10 % ,差异有显著性意义 ( P<0 .0 5 )。结论 :临床 T4 期时 ,如果肿瘤越过中线同时为低分化可考虑施行双侧颈廓清。对侧半喉受累中、重度的声门上喉癌者可考虑施行双侧颈廓清。临床 N2 及 N3病例应施行双侧颈廓清。

The clinical and pathological research of supraglottic carcinoma with bilateral cervical nodal metastasis

OBJECTIVE: To evaluate clinical and pathological characteristics in patients with supraglottic carcinoma and bilateral cervical nodal metastasis. METHOD: 60 patients with supraglottic carcinoma treated in this hospital from 1985 to 1994 were retrospectively reviewed, including 30 cases with bilateral metastasis (experiment group) and 30 cases with unilateral metastasis (control group). The two groups were contrasted according to site of tumor, tumor diameter, surface morphology, clinical staging, the degree of invading the contralateral semilarynx, Border's grading, growth mode of tumor edge, the degree of invading preepiglottic space. RESULT: In stage T4 cases with low grading of cell differentiation made up 63.6% (7/11) in the bilateral metastasis group, while 10% in the ipsilateral metastasis group (P < 0.05). Significant differences lied between N0 group and N2 group (P < 0.05). Moderate and severe invasion of contralateral semilarynx in the bilateral group made up 87.5% (14/16), significantly higher than that in ipsilateral group 53.3% (16/30). CONCLUSION: Bilateral neck dissection should be used in T4 cases with low grading of cell differentiation in which the contralateral semilarynx was invaded. Bilateral neck dissection should be taken for the treatment of supraglottic carcinoma with N2.3 diseases. Bilateral neck dissection is recommended for the patients with moderate and severe invasion of the contralateral semilarynx.