声门上癌术后颈淋巴结的转移与再发

探讨选择性颈廓清术在声门上癌手术治疗中的作用。方法总结１９８１－１９９３年治疗的５８２例声门上癌术后颈淋巴结转移及廓清侧转移淋巴结再发情况。结果Ｔ３、Ｔ４病例３９２例,而Ｔ３Ｎ＋、Ｔ４Ｎ＋１４７例。

Cervical lymph node metastasis and recurrence in supraglottic carcinoma after operation]

OBJECTIVE: To evaluate the regional control efficacy of elective neck dissection (END) in patients with supraglottic carcinoma. METHODS: The incidence of cervical recurrences of 582 patients with supraglottic carcinoma treated in this hospital from 1981 to 1993 were retrospectively reviewed. RESULTS: Three hundred and ninety-two cases (67.35%) of this group had T3 and T4 primary lesions. Among them, 147 cases (37.50%) had positive nodes(N+) and this accounted for 86.47% (147/170) of all N+ patients. Ipsilateral or bilateral cervical recurrence occurred in 33 of 126 (26.19%) node negative (N0) cases who had not had neck dissection and 30 of them (90.90%) were among T3 and T4 groups. However, Contralateral lymph node recurrence occurred only in 40 of 286(13.99%) N0 cases who had had END and 30 of them (75%) were among T3 and T4 groups. There were 163 cases who were readmitted and received surgery again for different purposes. The three and five year survival rates in the second stage END group were 86.67% and 77.78%, in metastasis group 64.81% and 32.50%, in recurrent group 33.33% and 30.77% respectively. There were significant differences in survival rates among these groups. CONCLUSION: Patients underwent elective neck dissection achieved better survival than those on "wait and watch" policy and salvage surgery. Elective neck dissection is recommended for the treatment of supraglottic carcinoma, especially for the T3 and T4 diseases.