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目的:探讨择区性颈清扫术(SND)治疗下咽鳞状细胞癌颈部淋巴结转移的手术范围。方法:回顾性分析接受SND的26例下咽癌患者,其中11例cN0患者,15例cN+患者。本组共有51侧的SND,其中34侧为选择性SND,17侧为治疗性SND。结果:发现隐匿性颈淋巴结转移6例(55%),颈淋巴结转移均限制在Ⅱ区和Ⅲ区内。cN+患者均证实有颈淋巴结转移,其中Ⅱ区转移占66.7%,Ⅲ区转移占86.7%,Ⅳ区转移占46.7%,Ⅴ区转移占20.0%,另外Ⅰ区仅1例发现转移(6.7%)。随访发现区域复发4例,均为cN+患者,且均未见Ⅰ区复发。结论:cN0下咽癌患者SND(Ⅱ～Ⅲ)清扫有一定的临床意义,尚需进一步验证;cN+患者Ⅰ区清扫尚无必要,SND(Ⅱ～Ⅴ)配合术后放疗能取得满意的疗效。
Objective: To explore the surgical range of cervical lymph node metastases by selective regional neck dissection (SND) in the treatment of squamous cell carcinoma of the mouth. METHODS: Twenty-six patients with hypopharyngeal carcinoma undergoing SND were retrospectively analyzed, including 11 patients with cN0 and 15 patients with cN +. This group a total of 51 SND, 34 sides for the selective SND, 17 side for the treatment of SND. Results: Six cases (55%) of occult cervical lymph node metastasis were found, and cervical lymph node metastasis was limited in Ⅱ and Ⅲ area. The metastasis of cervical lymph node was confirmed in 66 cases of cN + patients. The metastasis of zone Ⅱ was 66.7%, the metastasis of zone Ⅲ was 86.7%, the metastasis of zone Ⅳ was 46.7%, the metastasis of zone V was 20.0% and the other was only 1 case (6.7%), . Follow-up found regional recurrence in 4 cases, both cN + patients, and no recurrence of the area. Conclusion: SND (Ⅱ ~ Ⅲ) in patients with cN0 hypopharyngeal carcinoma have certain clinical significance, further validation is needed. In the cN + patients, it is not necessary to provide clearance in area Ⅰ. SND (Ⅱ ~ Ⅴ) combined with postoperative radiotherapy can achieve satisfactory results.