声门上型喉癌患者两期双侧颈淋巴结清扫术的疗效比较

目的 :总结双侧颈淋巴结清扫术在处理声门上型喉癌颈部淋巴结转移癌中的临床意义。方法 :对76例声门上型喉癌患者在切除原发灶同时 ,将术前诊断双侧颈淋巴结转移的 33例进行同期双侧颈清扫术 (同期清扫组 ) ;一侧颈部淋巴结转移的 43例行一侧颈清扫术 ,随诊中发现对侧转移再行 2期对侧颈清扫术 (分期清扫组 )。结果 :同期清扫组 3年生存率为 81.5 % (2 2 / 2 7) ,5年生存率 6 1.5 % (16 / 2 6 ) ;1例术后当天死于脑压增高。分期清扫组 3年生存率为 6 9.2 % (2 7/ 39) ,5年生存率 2 7.8% (10 / 36 ) ;1例术后当天呼吸道梗阻死亡。结论 :声门上型喉癌双侧颈转移淋巴结同期清扫术 ,比双侧分期清扫术期能明显提高患者的生存率。术中尽可能保留双侧颈内静脉 ,必要时行血管吻合重建颈内静脉 ,能减少术后的并发症。     

下咽癌颈淋巴结转移的颈侧清扫探讨

目的 为了探讨颈侧清扫可否应用于临床Ｎ＋的下咽癌的颈部治疗。方法 对９３例下咽部颈清扫标本的转移性淋巴结在颈部的分布进行了回顾性分析。结果 颌下淋巴结转移占３．２％。Ｎ０,Ｎ１,Ｎ２ａ和Ｎ２ｂ～Ｎ３的颈后三角淋巴结转移率分别为：５．９％,７．０％,３７．５％和３６．０％。病理证实仅有颌下淋巴结转移或上、中颈深淋巴结转移,而无下颈深淋巴结转移时,颈后三角淋巴结转移率为４．０％,有下颈深淋巴结转移时,     

颈侧清扫术

正颈淋巴结清扫术是治疗头颈肿瘤颈淋巴结转移的重要方法,能够有效提高头颈肿瘤的治疗效果。颈择区性清扫术是颈淋巴结清扫术的常用术式,依据清扫区域不同可分为颈肩胛舌骨肌上清扫术、颈肩胛舌骨肌上扩大清扫术、颈侧清扫术、颈后侧清扫术、颈中央区清扫术,需依据原发肿瘤部位及T分期、淋巴结N分期不同,采取不同的颈侧清扫术策略。我们将结合手术视频说明颈侧清扫术(Ⅱ-Ⅳ区)的基本手术方法。     

颈淋巴结清扫对临床颈淋巴结阴性伴高危因素甲状腺乳头状癌治疗的意义

目的 探讨临床颈淋巴结阴性(cN0)伴高危因素甲状腺乳头状癌(papillary thyroid cancer,PTC)的颈淋巴结转移规律,并对其行选择性清扫的必要性.方法 回顾性分析87例临床颈淋巴结阴性伴高危因素甲状腺乳头状癌初次行甲状腺癌手术并同期行颈清扫术患者的临床资料,对结果进行统计学分析.结果 87例(89侧)患者中,颈淋巴结阳性率62.9％,其中中央组淋巴结(Ⅵ区)转移率58.4％,颈侧区(Ⅱ一Ⅳ)阳性率38.2％,Ⅵ区与颈侧区淋巴结阳性率比较,差异有统计学意义(配对x2检验,x2=11.12,P＜0.01),同时行关联性分析表明,VI区与颈侧区转移有相关性(x2=20.11,P＜0.05,Pearson列联系数C=0.43).Ⅵ区阳性者,Ⅱ、Ⅲ、Ⅳ区淋巴结转移率分别为30.8％、61.5％、42.3％,颈侧各区之间转移率差异有统计学意义(x2=10.30,P＜0.01).结论 cN0伴高危因素PTC患者,Ⅵ区与颈侧区淋巴结转移有相关性,且Ⅵ区阳性者,颈侧各区之间转移率有差异,建议此类患者在常规清扫VI区淋巴结基础上进一步行颈侧清扫术,并可根据肿瘤位于甲状腺不同部位,选择颈侧各区的清扫范围.     

颈淋巴结转移临床处理概念上的变化─—分区性颈清扫术

分区性颈清扫术（selectiveneckdissection,SND）是根据头颈部特定部位肿瘤颈淋巴结转移规律而设定的非全颈性清扫,手术范围缩小而不影响根治性。有利于保留患者外观和术后功能。SND目前主要应用于临床颈淋巴结阴性（cN0）和部分阳性（cN1）的上呼吸消化道鳞癌患者,有多个淋巴结转移或术后病理提示淋巴结有包膜外侵犯的患者应配合应用放疗。不同术式的分区性颈清扫适应于不同原发灶的转移。治疗结果显示SND治疗后的效果及手术区域颈部淋巴结复发率与改良根治性颈清扫相似。     

颈廓清术的几点改进(附65例报告)

目的：探讨颈廓清手术的方法以提高治疗效果。方法：于65例头颈肿瘤患者行颈廓清术时,对切口、探查入路及手术操作作了部分改进。结果：65例颈廓清术时间平均为110min,术中出血量平均为120ml,手术并发症发生率降至1．54％,术后2年生存率为86．2％（56／65）,3年生存率81．6％（31／38）。结论：改进后的颈廓清术,手术时间缩短,术中出血减少,并发症少,近期疗效有所提高。     

颈清扫术治疗晚期颈转移癌的远期效果及复发相关因素分析

目的 探讨颈清扫术治疗晚期颈转移癌的远期效果及术后颈部复发的相关影响因素。方法 对112例接受全颈清扫手术的头颈部鳞状细胞癌N2、N3患者，利用手术标本病理检查及随访资料进行回顾性分析。结果 晚期颈转移癌全颈清扫术后5年颈部复发率为27．7％(31／112)，其中N2、N3患者的术后5年颈部复发率分别为16．5％(13／79)、54．5％(18／33)。31例全颈清扫术颈部复发患者，Kaplan-Meier法统计术后3年生存率、5年生存率分别为16．1％(5／31)、9．7％(3／31)。单因素χ^2分析显示，临床N分期、病理颈淋巴结大小、转移淋巴结包膜外扩散、颈部非淋巴组织结构受侵情况与术后颈部复发有关。多因素Logistic回归分析结果表明，仅病理检查颈淋巴结大小与术后颈部复发明显相关。结论 颈部复发是晚期颈转移癌患者最常见的术后肿瘤复发原因。转移颈淋巴结大小是全颈清扫术后颈部复发根本和决定性影响因素。而临床N分期、转移淋巴结包膜外扩散、颈部非淋巴组织结构受侵情况对全颈清扫术后颈部复发具有重要影响。     

声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择

目的 探讨声门上型喉癌临床诊断NO(clinical NO,cNO）患者颈淋巴结转移的特点，选择合理的清扫区域。方法 5例声门上型喉癌患者行喉切除术的同时行改良性颈清扫术，将颈清扫的淋巴结标本分区域逐一行病理学检查，确定转移区域或复发的区域。结果 57例（63侧）颈清扫标本共获淋巴结1877枚，平均每侧获29．8枚，有转移的43枚，其中41枚位于Ⅱ、Ⅲ区，占转移例数的95．4％（41／43）。15例（17侧）患者有淋巴结转移，转移率为26．3％（15／57）。其中14例位于Ⅱ、Ⅲ区，占转移例数的93．3％（14／15）。颈部复发3例，复发率为5．3％（3／57），复发部位分别为Ⅱ、Ⅲ、Ⅳ区。5年生存率为80．7％（46／57）。结论 对声门上型喉癌cNO重点行Ⅲ和Ⅲ区颈淋巴结清扫术，Ⅲ区受累时应包括Ⅳ区，Ⅰ、Ⅴ区在无明显转移证据时可避免行颈清扫术。     

头颈部鳞癌颈淋巴结隐匿性转移

目的探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法对111例头颈部鳞癌N0M0患者的颈淋巴结清扫标本进行切片观察。结果隐匿性转移总体发生率为26．12％(29／111)。其中口腔癌18．75％(15／80)，口咽癌25．00％(1／4)，下咽癌54．54％(6／11)，喉癌43．75％(7／16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N0M0患者5年生存率为66．7％，其中pN^-为74．39％(61／82)，pN^ 为44．82％(13／29)。结论对临床T3和T4期、癌组织分化程度低和深度浸润的cN0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

Planned postradiotherapy bilateral neck dissection for head and neck cancer

Purpose: This is a retrospective analysis of 50 patients with squamous cell carcinoma of the head and neck treated with radiotherapy (RT) to the primary site and bilateral neck followed by a planned bilateral neck dissection approximately 4 to 6 weeks after completion of RT.Patients and Methods: Between November 1964 and March 1997, 50 patients underwent bilateral neck dissections after RT, with minimum 2-year follow-up. Forty-eight patients had bilateral positive neck nodes.Results: At 5 years, the rates of neck disease control, local-regional control, and cause-specific survival were 76%, 70%, and 39%, respectively. Five severe complications developed after surgery, and 1 developed after RT.Conclusions: Radiotherapy followed by a planned bilateral neck dissection resulted in a high rate of local-regional control with acceptable morbidity. The likelihood of severe complications after simultaneous (as opposed to staged) neck dissection was not significantly different (P = .24). (Am J Otolaryngol 2001;22:383-386.     

Second primary tumors in head and neck cancer

IntroductionThe development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions.PurposeTo define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer.Material and methodRecords of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT.ResultsThe overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group).ConclusionBecause of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.     

同期双颈淋巴廓清术37例分析

目的探讨同期实施双颈淋巴廓清术提高癌症患者生存率的可能性.方法头颈部癌伴双颈淋巴转移,在切除原发灶的同时一期行双颈淋巴廓清术.根据淋巴结的大小及分布范围,分别采用4种术式,(1)经典性全颈清扫术;(2)改良性全颈清扫术;(3)分区性颈清扫术;(4)颈扩大清扫术.结果经随访,3年生存率为62.1%(23/37),5年生存率为37.8%(14/37).并发症有乳糜漏2例,血肿2例,颈皮瓣延期愈合1例,严重面部软组织水肿5例.无因手术而死亡或偏瘫者.结论为了提高癌症患者的生存率及生存质量,只要严格掌握手术适应证,术中(至少)保留一侧颈内静脉,同期行双颈淋巴廓清并发症不重,手术是安全可行的.     

Neck dissection findings in primary head and neck high-grade adenocarcinoma

Primary salivary adenocarcinoma of the head and neck is rare. In cases where cervical metastases are evident or suspected, neck dissection is likely to play a role in management. However, there is little data in the literature regarding the findings and outcome of neck dissection in these patients. The present study comprised a review of 12 patients with high-grade salivary adenocarcinoma (salivary ductal carcinoma or adenocarcinoma, not otherwise specified (NOS). Eight underwent neck dissection (four modified radical, four selective). Histological examination showed evidence of cervical metastases in five. The prevalence of occult metastases in the N(0) neck was 40 per cent. Computed tomography (CT) and magnetic resonance imaging (MRI) were not useful in detecting occult neck disease. Five patients had no evidence of disease at the most recent follow up. Neck dissection is indicated in patients with high-grade salivary adenocarcinoma, and may provide information for planning adjuvant treatment.     

Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma

Selective neck dissection (SND) is known to be a valid procedure to stage the clinically N0 neck but its reliability to control metastatic neck disease remains controversial. This study analysed if selective neck dissection is a reliable procedure to prevent regional metastatic disease in head and neck squamous cell carcinoma (HNSCC). We retrospectively analysed the medical records of 163 previously untreated patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx treated initially in our departement from January 1990 to December 2002. All patients had unilateral or bilateral SND, in combination with surgical resection of the primary tumour. SND was performed in 281 necks. Finally, 146 patients who underwent 249 SND (39 I–III, I–IV, 210 II–IV, II–V) had adequate follow-up and were assessed for the regional control. The median follow-up was 37 months (1–180 months). The end points of the study were neck control following SND and overall survival. Twenty-five percent (30/119) of patients staged cN0 had lymph node (LN) metastasis. Overall, regional recurrence was observed in 2.8% of the necks (7/249): 1.6% (4/249) in dissected field and 1.2% (3/249) in undissected field. Seventy-eight percent (194/249) of the necks were staged pN0 with a subsequent failure rate of 1.5% (3/194); 16% (39/249) were staged pN1 and postoperative radiotherapy (PORT) was proposed in 21 of these patients. The failure rate with PORT was 9.5% and 5.5% without PORT. Six percent (16/249) of the necks were staged pN2b and all had PORT with one subsequent recurrence. Extracapsular spread (ECS) was reported in 16.5% of positive SND specimens (9/55); all by one were treated by PORT with a subsequent failure rate of 22% (2/9). At 3 years, overall survival for the whole population was 70% and statistically highly correlated with pN stage (p<0.001). These results support the reliability of SND to stage the clinically N0 neck. SND is a definitive operation not only in pN0 but also in most pN1 and pN2b necks. PORT is not justified in pN1 neck without ECS. In pN2b necks, the low rate of recurrence supports adjuvant PORT. The presence of ECS, despite adjuvant PORT, remains associated with a higher risk of recurrence.     

Metastases from distant primary tumors to the head and neck

The authors present 12 patients with metastases to the head and neck from neoplasm located in distant places treated from 1980 to 2002. Most of the metastatic tumors were located in neck lymph nodes--7 cases, the others were located in neck lymph nodes and cerebellum (1), in the nasal cavity, paranasal sinuses and brain (1), in the maxilla and zygomatic bone (1) in the frontal bone (1) and in the orbit (1). In 8 cases metastatic tumor was the first symptom of neoplastic disease. The others--4 cases--were found 1 to 12 years after diagnosis of neoplastic disease. Primary tumors were located in lungs, kidneys and breast.     

Elective treatment of the neck for second primary tumors of the head and neck

The aim of this study was to define the role of elective neck dissection in patients with a second N0 head and neck squamous cell carcinoma (HNSCC). We carried out a retrospective study in 74 patients with a second N0 HNSCC treated with an elective neck dissection. Thirteen patients (17.6 %) had occult neck node metastases. The risk of occult neck nodes was low for patients with a second glottic tumor (0 %), and for patients with non-glottic T1–T2 tumors who had received previous radiotherapy in the neck (5.3 %). Patients with non-glottic locally advanced tumors (T3–T4) and non-glottic T1–T2 tumors who had not received previous radiotherapy in the neck had a risk of occult neck nodes of 28.1 and 33.3 %, respectively. Elective neck dissection could be omitted in patients with glottic tumors and in patients with an early tumor (T1–T2) who had received previous radiotherapy in the neck.