声门上型喉癌cN0患者双侧颈部外科处理方式探讨

目的探讨声门上型喉癌临床颈淋巴结阴性(clinical lylymph node negative,cN0)患者双侧颈部转移淋巴结的处理方法。方法对4年间32例声门上型喉癌(尤其是位于中线者)临床cN0患者采用一侧或病变主体侧颈部Ⅱ、Ⅲ区清扫术,术中送冰冻病理检查,根据病理结果,决定对侧是否手术治疗。实施手术侧术中冰冻检查证实淋巴结转移阳性者,同时实施对侧手术;阴性者,对侧颈部随访观察。结果32例患者中11例术中冰冻检查阳性而行对侧清扫术,双侧手术的实施率为34.4%(11/32);对侧有6例术后病理证实有淋巴结转移,有效率为54.5%(6/11)。结论声门上型喉癌cN0患者Ⅱ、Ⅲ区手术可解决大部分早期病变,应用一侧或病变主体侧的诊断治疗性颈清扫手术来决定对侧手术方案,在一定程度上可达到微创和有的放矢的双重目的。

The Strategy of Bilateral Neck Dissection in cN0 of Supraglottic Laryngeal Cancer

Objective To investigate the surgical strategy for bilateral cN0 supraglottic laryngeal cancer. Methods Between 1998 and 2002, 32 cases of supraglottic cancer(especially located at midline) with bilateral cN0 necks were treated using ipsilateral selective neck dissection within level Ⅱ and Ⅲ in surgery, after completing the dissection the obtained specimens were detected using frozen section. If the lymph nodes were positive, the contralateral regional neck dissection of level Ⅱ and Ⅲ were conducted. If negative, the contralateral neck was spare and follow-up. Results In 11 of 32 cases of supraglottic cancer of larynx bilateral neck dissections was conducted depending on the results of frozen pathologic results. The bilateral neck dissections rate was 34.4%(11/32) and 6 of this 11 necks contained metastasis, the effective rate was 54.5%(6/11). Conclusion The neck dissection of level Ⅱ and Ⅲ could be used in cN0 necks of supraglottic cancer of larynx. The strategy of contralateral selective neck dissection conducted depending on one side frozen section results can be used and provided us a reasonable trail on the bilateral cN0 patients of supraglottic cancer.