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目的分析鼻咽癌放疗后颈淋巴结残留和复发者的4种清扫方式的疗效,希望能为临床提供更多手术方式的选择。方法回顾性分析88例鼻咽癌患者资料,分析总体疗效生存率、复发率、远处转移率和手术并发症;比较全颈清扫、改良性、择区性颈清扫术和颈淋巴结切除术4种手术方式的生存率、复发率;比较术后颈部放疗与否者的生存率、复发率。结果采用生命表法统计88例鼻咽癌患者5年累积生存率428%,颈淋巴结复发率为227%。Ⅱ期、Ⅲ期、Ⅳ期患者的5年生存率(生命表法)分别为567%、361%、324%。全颈清扫术、改良性颈清扫术、择区性颈清扫术和颈淋巴结切除术组5年累积生存率(KaplanMeier法)分别为398%、600%、379%和441%,差异无统计学意义(LogRank统计值=10,P=08011),颈淋巴结复发率差异也无统计学意义(χ2=0470,P=0493)。颈清扫术后颈部给予与未给予术后放疗者的5年累积生存率(KaplanMeier法)分别为391%和453%,差异无统计学意义(LogRank统计值=006,P=08138),颈淋巴结复发率差异也无统计学意义(χ2=0593,P=0441)。结论只要合理选择病例,配合必要的术后局部和浅表的放疗,4种清扫方式都能有效和安全地控制肿瘤。
Objective To analyze the curative effect of four kinds of cleaning methods for residual and recurrence of cervical lymph nodes after radiotherapy of nasopharyngeal carcinoma, hoping to provide more options for clinical operation. Methods The data of 88 patients with nasopharyngeal carcinoma were retrospectively analyzed. The overall survival rate, recurrence rate, distant metastasis rate and surgical complications were analyzed. The results of total neck dissection, modified neck dissection and neck dissection 4 The survival rate and recurrence rate of the surgical methods were compared. Survival rate and recurrence rate were compared between the two groups. Results The life table method was used to calculate the 5-year cumulative survival rate of 88 NPC patients 428% and the recurrence rate of cervical lymph nodes 227%. The 5-year survival rates (life table method) for stage II, stage III, and stage IV patients were 567%, 361%, 324%, respectively. The 5-year cumulative survival rates were 398%, 600%, 379% and 441% for neck dissection, neck dissection, neck dissection and cervical lymph node dissection Significance (LogRank = 10, P = 08011), cervical lymph node recurrence rate difference was not statistically significant (χ2 = 0470, P = 0493). The 5-year cumulative survival rates after neck dissection were significantly different from those without postoperative radiotherapy (Kaplan Meier method) (391% and 453%, respectively), with no significant difference (LogRank = 006, P = 08138) Lymph node recurrence rate difference was not statistically significant (χ2 = 0593, P = 0441). Conclusion As long as the reasonable choice of cases, with the necessary local and superficial postoperative radiotherapy, 4 kinds of cleaning methods can effectively and safely control the tumor.