【摘要】 目的　探讨T2 4临床N0 (clinicalN0 ,cN0 )喉癌颈淋巴结转移特点 ,为颈淋巴结的正确处理提供依据。方法　 76例T2 4cN0喉癌患者被随机分为颈根治性清扫术 (radicalneckdissection ,RND)及颈功能性清扫术 (functionalneckdissection ,FND)两组。分别完成 2 1例 (2 2侧 )和 5 5例 (6 0侧 )。将所获淋巴结按区标记并逐一行病理检查 ,以确定转移情况。结果　RND组平均每侧获淋巴结 2 9 6枚 ,FND组 2 4 7枚 ,差异无显著性 (F =3 4 15 ,P =0 0 6 8)。两组颈淋巴结转移率分别为 33 3% (7/ 2 1)和 34 5 % (19/ 5 5 ) ,总转移率为 34 2 % (2 6 / 76 )。 2 6例颈淋巴结阳性者中 2 5例 (96 2 % )位于Ⅱ、Ⅲ区。共获淋巴结 2 130枚 ,转移阳性淋巴结 6 0枚 ,其中 5 9枚 (98 3% )位于Ⅱ、Ⅲ区。 5年、10年生存率分别为 75 % (5 7/ 76 )、6 6 7% (44 / 6 6 ) ;两组的 5年和 10年生存率分别为 71 4 % (15 / 2 1)、76 4 % (42 / 5 5 )和6 1 9% (13/ 2 1)、6 8 9% (31/ 4 5 ) ,统计学差异均无显著性 (χ2 =0 2 394 ,P >0 5 ;χ2 =0 314 3,P >0 5 )。颈部总复发率为 7 9% (6 / 76 ) ,两组分别为 9 5 % (2 / 2 1)和 7 3% (4/ 5 5 ) ,统计学差异无显著性 (χ2 =0 10 5 9,P >0 90 0 )。颈淋巴结阳性与阴性者 10年更多还原

【Abstract】 Objective To study the characteristics of the cervical lymph node metastasis in clinical N0(cN0) patients with laryngeal carcinoma and its implication in clinical treatment. Methods 76 patients with larygeal carcinomas of T2-4cN0 category were divided into two groups in random: 21(22 sides) radical neck dissection(RND) and 55(60 sides) functional neck dissection(FND) were performed. Lymph nodes were studied histologically according to the levels. Results On an average,29.6 lymph nodes were obtained in one side of neck in RND group,and 24.7 in FND group( F =3.145, P =0.068). The occult metastasis rates were 33.3%(7/21)in RND group and 34.5%(19/55) in FND group.25 of 26 patients (96.2%) who had positive nodes involved only the levels Ⅱ and Ⅲ.2130 lymph nodes were obtained in all samples,59 of 60 positive nodes(98.3%) were located in the level Ⅱ and Ⅲ. The 5 and 10-year survival rates of the two groups were 71.4%(15/21),76.4%(42/55) and 61.9%(13/21),68.9%(31/45),respectively with no statistical difference(χ 2=0.2394, P >0.5;χ 2=0.3143, P >0.5). Ipsilateral cervical recurrence rates in two groups were 9.5%(2/21) and 7.3%(4/55),respectively with no statistical difference (χ 2=0.1059, P >0.900). 10-year mortalities with negative and positive cervical lymph nodes were 16.7%(7/42) and 62.5%(15/24) respectively ,which had statistically difference (χ 2=14.4375, P <0.005). Conclusion The lateral neck (level Ⅱ,Ⅲ and Ⅳ) dissection may be suitable for the treatment laryngeal carcinoma patients with T2-4cN0.更多还原