择区颈部淋巴结清扫对cN0期声门上型喉癌的应用价值(1)
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[摘要] 目的：比较择区颈淋巴结清扫术和不予清扫的手术方式对cN0期声门上型喉癌的临床应用价值。方法：103例cN0期声门上型喉癌患者随机分为择区颈淋巴结清扫术组(n=52)和不予清扫组(n=51)两组，分别给予相应的治疗。术后随访3年。生存分析采用Kaplan-Meier曲线和Log-rank检验。结果：52例患者采取择区颈淋巴结清扫术，共清扫淋巴结1 126枚，平均21.7枚。共有14例患者检出颈淋巴结转移，占26.9%(14/52)。随着临床分期的提高，cN0患者实际颈淋巴结转移率逐渐增高(χ2=11.451， P=0.010)。转移的152枚淋巴结分布在颈Ⅱ区91枚(59.9%)，Ⅲ区42枚(27.6%)，Ⅳ区19枚(12.5%)。103例患者3年内共失访9例，随访率为91.3%。3年随访期内共有10例复发。择区清扫组患者3年内复发率为4.2%，不予清扫组为17.4%(χ2=4.321， P=0.038)。择区清扫组1、2年及3年的生存率分别为95.1%、91.4%和89.2%，不予清扫组为93.9%、86.2%和77.5%。择区清扫组术后生存优于不清扫组(χ2=3.316， P=0.014)。结论：①cN0期声门上型喉癌存在一定的隐匿淋巴结转移发生率，并且转移以Ⅱ、Ⅲ区最多见。②采取择区颈淋巴结清扫术既能较大程度的存留颈部的解剖结构，而较不予淋巴结清扫者又具有明显的改善术后生存的治疗优势。
[关键词] 喉癌；cN0期；择区颈淋巴结清扫术；预后
[中图分类号] R739.65 [文献标识码]A[文章编号]1674-4721(2011)08(a)-046-03
Selective neck lymph nodes dissection for cN0 supraglottic laryngeal cancer
TANG Zijiu
Department of Otolaryngology, Hunan Normal University Affiliated Xiangdong, Hunan Province, Liling 412200, China
[Abstract] Objective: To compare the selective neck lymph nodes dissection and no lymph nodes cleaning for cN0 supraglottic laryngeal cancer. Methods: 103 patients with cN0 supraglottic laryngeal were randomly divided into selective neck lymph nodes dissection group (n=52), and no lymph nodes dissection group (n=51). After 3 years followed up, we used Kaplan-Meier curve and Log-rank test for survival analyzed. Results: A total of 1 126 lymph node dissected form 52 patients in selective lymph nodes neck dissection group. The average number was 21.7. Total of 14 patients detected cervical lymph node metastasis 26.9%(14/52). With the improvement of clinical stage, cN0 actual cervical lymph node metastasis rate gradually increased (χ2=11.451, P=0.010). 91 cases (59.9%), 42 cases (27.6%), 19 cases (12.5%) of 152 lymph node metastasis distributed in the neck area of district Ⅱ, Ⅲ, Ⅳ, respectively. 9 patients lost in 3 years follow-up (91.3%). 10 patients recurrence in 3-year follow-up period, 4.2% recurrence rate in selective dissection group vs 17 ......
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