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目的 :探讨喉癌、下咽癌的颈淋巴结转移方式。方法 :对 5 0例喉癌、下咽癌患者于颈清扫术前 ,在喉及下咽粘膜下注射叶绿素使颈淋巴结系统染色 ,指导施行颈清扫术并收集淋巴结 ,进行连续切片观察。结果 :颈淋巴结被染成深绿色 ,与周围组织颜色对比明显 ,便于颈部手术和采集淋巴结 ;经病理检查证实 ,颈淋巴结总的转移率为 4 8% ,Ⅰ、Ⅴ区转移时均伴有其它区域的转移 ,Ⅱ、Ⅲ区转移率高于Ⅰ、Ⅳ、Ⅴ区 (P <0 .0 1) ;临床诊断颈淋巴结阴性 (cN0 )的患者淋巴结转移率为 2 3.5 % ,转移区域均在Ⅱ、Ⅲ区。结论 :临床诊断颈淋巴结阳性 (cN+ )喉癌、下咽癌患者的颈清扫手术 ,首先要保证清扫II、III区淋巴结 ,术中所见决定选择性颈清扫术式 ,对cN0 的下咽癌或声门上癌可行单侧或双侧颈深上、中淋巴结清扫术。叶绿素染色清晰 ,安全无毒 ,便于手术 ,可以在颈清扫术中常规应用
Objective: To investigate the cervical lymph node metastasis of laryngeal and hypopharyngeal carcinoma. Methods: Fifty cases of laryngeal carcinoma and hypopharyngeal carcinoma were stained with chlorophyll in the larynx and hypopharynx before the neck dissection. The neck dissection was performed and the lymph nodes were collected for serial section observation. Results: The neck lymph nodes were dyed dark green with obvious contrast with the surrounding tissues for neck surgery and lymph node collection. The pathological examination confirmed that the total lymph node metastasis rate was 48% The metastasis rates of other regions were higher than those of regions Ⅰ, Ⅳ and Ⅴ (P <0.01). The metastatic rate of lymph nodes was 23.5% in patients with cervical lymph node-negative (cN0) Ⅱ, Ⅲ area. CONCLUSIONS: To diagnose neck lymph node-positive (cN +) laryngeal cancer and hypopharyngeal carcinoma in patients undergoing neck dissection, it is first necessary to ensure the dissection of lymph nodes in zone II and III. The decision of selective neck dissection and cN0 hypopharyngeal carcinoma Or supraglottic cancer feasible unilateral or bilateral neck depth, the lymph node dissection. Chlorophyll stain clear, safe and non-toxic, easy to operate, can be used routinely in neck dissection