鼻咽癌治疗后颈淋巴结残留或复发的手术治疗(1)
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[摘要] 目的：探讨鼻咽癌治疗后颈淋巴结残留或复发的手术治疗的疗效。方法：回顾性分析我院57例因鼻咽癌放疗后颈淋巴结残留或复发行颈清扫术的患者，应用Kaplan-Meier法进行生存率分析，采用COX回归模型对影响生存率的相关因素进行分析。结果：术后1﹑3﹑5年生存率分别为82.1%﹑54.8%﹑34.7%。多因素分析表明，放疗后至手术之日的间隔时间超过24个月，复发或残留淋巴结再分期较晚，淋巴结外侵犯预后差。结论：颈淋巴结清扫术为治疗鼻咽癌放射治疗后颈淋巴结残留或复发的有效方法，可以提高患者的生存率。
[关键词] 鼻咽癌；颈淋巴结清扫术；残留；复发；放射治疗
[中图分类号] R739.6 [文献标识码] B [文章编号] 1673-7210(2011)11(b)-183-03
Surgical management of persistent or recurrent cervical lymph node in patients with nasopharyngeal carcinoma afrer radiotherapy
ZHANG Zheng, TAO Zhongqiang, ZHOU Rijing, QIN Ying, LU Jinlong, HUANG Bo, ZHOU Fuling, SI Yongfeng
Department of Otolaryngology Head and Neck Oncology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
[Abstract] Objective: To explore the effect of radical neck dissection performing of patients with nasopharyngeal carcinoma who had persistent or recurrent cervical lymph nodes after radiotherapy. Methods: 57 patients with lymph node persistence or recurrent after radiotherapy receiving radical neck dissection were analyzed retrospectively. The cumulative survival rate was analyzed by a Kaplan-Meier method. The Influencing factors were screened by COX proportional hazards model. Results: The 1-year, 3-year and 5-year overall survival rates were 82.1%, 54.8%, 34.7%, respectively; multivariate analysis showed that significant factors influencing survival included interval between completion of radiotherapy and surgery, the outside tissues of lymph node involved or not, and rN stage. Conclusion: Radical neck dissection can improve survival rate of patients with nasopharyngeal carcinoma who have persistent or recurrent cervical lymph nodes after radiotherapy.
[Key words] Nasopharyngeal carcinoma; Radical neck dissection; Persistent; Recurrence; Radiotherapy
鼻咽癌多为未分化非角化癌，对放射治疗敏感，目前治疗以单纯放疗或放化疗结合为主[1]。尽管颈淋巴结转移灶区、颈淋巴引流区均接受放射治疗，但仍有6%~18%的患者出现残留或复发[2-4]，影响鼻咽癌患者的生存率。笔者回顾性分析了57例因鼻咽癌放射治疗后颈部淋巴结残留或复发行颈淋巴结清扫术的患者，讨论其生存情况及预后因素。
1 资料与方法
1.1 一般资料
选取1996年1月~2003年12月我院收治的放疗后颈部淋巴结残留或复发，愿接受行颈清扫术的患者57例。其中，男45例，女12例；年龄26～71岁，平均(47.1±10.2)岁。所有患者首程治疗均接受根治性放射治疗 ......
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