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目的:探讨放疗后复发的喉癌(cN0)患者行颈淋巴结选择性清扫而检测出隐匿转移灶情况,分析肿瘤分期、并发症及术后生存率与隐匿转移灶之间的关系。方法:分析我院2005-2008年首选放疗后复发而行全喉切除加双侧颈廓清的喉癌(cN0)患者24例(声门型16例,声门上型8例),选择同期首选全喉切除加双侧颈廓清的喉癌(cN0)患者28例(声门型18例,声门上型10例)做对照。结果:放疗复发喉癌隐匿转移灶(7/24)高于未经放疗喉癌患者的隐匿转移灶(5/28);术前分期较高、周围组织破坏(如软骨或神经侵犯)的患者出现隐匿转移灶的比例较高;声门上型喉癌的隐匿转移灶高于声门型;随访期生存率与对照组相比,差异无统计学意义。结论:对放疗复发癌淋巴结(cN0),特别是T3、T4期的cN0复发喉癌患者,应行双侧Ⅰ～Ⅳ区淋巴结清扫,避免隐匿转移灶遗留。
Objective: To investigate the selective dissection of cervical lymph nodes in patients with recurrent laryngeal cancer (cN0) after radiotherapy to detect the occult metastasis, and to analyze the relationship between the tumor staging, complications and postoperative survival rate and occult metastases. Methods: Twenty-four patients (16 cases of glottis type and 8 cases of glottis type) with laryngeal cancer (cN0) who underwent total laryngectomy plus bilateral neck clearance who were the first choice after radiotherapy in our hospital from 2005 to 2008 were selected. Twenty-eight patients (glottic eighteen cases and supraglottic ten cases) with total laryngectomy and bilateral neck dissection (cN0) were recruited as controls. Results: The occult metastasis in laryngeal cancer with radiotherapy (7/24) was higher than that in patients without laryngeal cancer (5/28). Patients with high preoperative staging and surrounding tissue destruction (such as cartilage or nerve invasion) There was a higher proportion of occult metastases; supraglottic laryngeal carcinoma occult metastasis was higher than glottis type; follow-up survival rate compared with the control group, the difference was not statistically significant. Conclusion: Patients with cN0 recurrent cancer lymph nodes (cN0), especially stage T3 and T4 recurrent laryngeal cancer, should be treated with lymph node dissection in Ⅰ ~ Ⅳ area to avoid occult metastasis.