头颈部恶性肿瘤咽后间隙淋巴转移的诊断和手术治疗

目的探讨头颈部恶性肿瘤咽后间隙淋巴转移的临床表现、手术方法及其疗效。方法总结伴咽后间隙淋巴结肿大的6例头颈恶性肿瘤患者的临床表现。其中，声门上型喉癌（T3N2M0）2例（高、中分化鳞癌各1例）、下咽中分化鳞癌（T3N2M0）、口咽中分化鳞癌（T2N2M0）、鼻腔恶性黑色素瘤（TXN2M0）及甲状腺乳头状癌（TXN2M0）各1例。由CT和（或）MRI影像测得咽后间隙肿大淋巴结的直径为1．5～2．5cm，在控制原发灶和颈部转移淋巴结的基础上行咽后间隙淋巴清扫，并单独送病理检查。结果6例咽后间隙清扫标本均见转移，均为单发。其中1／2者4例，1／3者2例，且均伴颈内静脉链淋巴转移，分别为3／15，3／17，4／19，5／19，6／20和6／23。无颅神经损伤和咽瘘发生。下咽癌患者2年后死于肺转移；鼻腔恶性黑色素瘤者第3次手术后14个月复查时无复发，后失访；口咽癌患者术后18个月局部复发，2年后死亡。其余3例患者随访2～4年均无瘤生存。结论CT和MRI是诊断咽后间隙淋巴转移的主要手段，该处淋巴清扫是比较安全的。

Diagnosis and surgical management of metastatic diseases in retropharyngeal space

OBJECTIVE: To evaluate the symptoms and surgical mangement results of metastatic disease in the retropharyngeal space. METHODS: Six patients with malignant tumors were collected, in which enlarged lymphy nodes presented both in neck and retropharyngeal space. They consisted of two supraglottic carcinoma (T3N2MO), one thyroid carcinoma (TXN2MO), one nasal melanoma (TXN2MO), one oropharyngeal carcinoma (T2N2M0) and one hypopharyngeal carcinoma (T3N2MO). The enlarged nodes in the retropharyngeal space were measured with CT and (or) MRI, which ranged from 1.5-2.5 cm in diameter. Based on the control of the primary and neck disease, the mass in the retropharyngeal space was dissected and sent for pathologic exam separately. RESULTS: Metastasis in the retropharyngeal space was pathologically proved in all of them, along with the involved internal jugular lymphnodes of 3/15, 3/17, 4/19, 5/19, 6/20, and 6/23, respectively. No serious complications occurred, such as fistula and central nerve damage. The patient with hypopharyngeal carcinoma died of lung metastasis 2 years after operation. The one suffering nasal malignant melanoma was out of follow-up in the 14th months. The patient with oropharyngeal carcinoma locally relapsed in the 18th months and died at the 24th months postoperatively. The rest was alive with tumor free within the follow-up period from 2 to 4 years. CONCLUSIONS: CT or Mifi are the mainstay of diagonosis of the metastatic disease in the retropharyngeal space and can he surgically controlled with safety.