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目的 :回顾分析我院 1990年 4月～ 2 0 0 0年 4月收治的喉癌患者 2 89例颈部转移淋巴结的分布情况 ,指导颈清扫手术。方法 :将 2 89例分为 3组 :第 1组 :颈清扫术后有转移淋巴结的分布 (181例 ) ;第 2组 :术后病理诊断阴性淋巴结的免疫组化研究 (71例 ) ;第 3组 :未清扫者随访中再转移淋巴结的分布研究 (37例 )。结果 :第 1组清扫 2 4 2侧 ,颈部Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区转移率分别为 2 .8%、98.3%、32 .6 %、15 .0 %、13.0 %、2 1.4 % ;第 2组 71例 ,其中 4 6例 (5 0侧 )免疫组化研究发现 13个淋巴结内有微灶转移 ,分布于 11例患者中 ,所有转移淋巴结均分布在Ⅱ区 ;第 3组 37例 ,施行挽救性手术共 4 5侧 ,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区转移率分别为 2 .2 %、10 0 %、4 8.9%、2 6 .7%、13.3%。结论 :喉癌首先转移和主要转移部位为Ⅱ区 ,其次为Ⅲ区 ;Ⅳ、Ⅴ区发生率则较低 ,颌下区几乎不发生转移。喉癌患者的颈清扫应在常规清扫颈侧Ⅱ～Ⅳ区淋巴结的同时 ,根据病变范围情况行Ⅳ区的清扫 ,对颌下三角和颈后三角 (Ⅴ区 )在无影像学和术中证实的条件下 ,应予以保留 ,以缩短手术操作时间和减少术后并发症的发生
OBJECTIVE: To retrospectively analyze the distribution of cervical lymph node metastasis in 2 89 cases of laryngeal cancer admitted to our hospital from April 1990 to April 2000, and to guide the neck dissection. Methods: Two hundred and eighty-nine patients were divided into three groups: Group 1: the distribution of metastatic lymph nodes after neck dissection (181 cases); Group 2: immunohistochemical study of negative lymph nodes after pathological diagnosis (71 cases); Group 3: Distribution of re-metastatic lymph nodes in patients who had not been followed up (37 cases). Results: In the first group, the metastatic rates of Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ in the neck were 24.4%, 98.3%, 32.6%, 15.0% and 13.0% respectively, 2 of 71 cases, of which 46 cases (50 sides) immunohistochemical study found that there are 13 lymph node micrometastasis, distributed in 11 patients, all metastatic lymph nodes are located in the area Ⅱ; the first 37 cases in 3 groups were treated with salvage operation. The metastasis rates of Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ were respectively 2. 2%, 10 0%, 4 8.9%, 26.7% and 13.3%. CONCLUSION: The primary metastasis and metastasis of laryngeal carcinoma are in zone Ⅱ, followed by zone Ⅲ. The incidence of laryngeal carcinoma in stage Ⅳ and V is lower, and the submandibular area hardly metastasizes. The neck dissection of laryngeal cancer should be carried out in the conventional cervical lymph node dissection Ⅱ ~ Ⅳ area at the same time, according to the scope of disease line Ⅳ area of the submandibular triangle and the posterior triangle (Ⅴ area) in non-imaging and intraoperative confirmation Conditions, should be retained to shorten the operation time and reduce the incidence of postoperative complications