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目的:研究下咽癌颈部淋巴结转移的临床规律,辅助下咽癌治疗。方法:回顾性分析45例下咽癌55侧颈淋巴结清扫术,分析颈部出现淋巴结转移及结外侵犯与临床病理因素的关系。结果:①45例下咽癌颈部淋巴结转移率为75.56%,10例双侧清扫中5例(11.11%)为双侧转移,2例(4.44%)为单侧转移;转移淋巴结结外侵犯率为79.41%,2例(5.88%)为双侧清扫双侧结外侵犯,2例(5.88%)为双侧清扫单侧结外侵犯。②45例共清扫淋巴结411枚,转移淋巴结163枚,转移率为39.66%,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区转移淋巴结构成比分别为0.61%、49.08%、25.77%、21.47%、3.07%,各区转移率分别为3.57%、62.02%、37.17%、42.17%、8.62%;③Ⅰ+Ⅴ、Ⅱ+Ⅲ+Ⅳ比较差异有统计学意义;Ⅰ、Ⅴ比较差异无统计学意义;Ⅱ、Ⅲ、Ⅳ比较差异有统计学意义;Ⅱ、Ⅲ+Ⅳ比较差异有统计学意义;Ⅱ、Ⅲ比较差异有统计学意义;Ⅱ、Ⅳ比较差异有统计学意义;Ⅲ、Ⅳ比较差异无统计学意义;Ⅰ、Ⅴ分别与Ⅱ、Ⅲ、Ⅳ、Ⅱ+Ⅲ+Ⅳ比较均差异有统计学意义。④T1+T2与T3+T4两组之间和T1、T2、T3、T4任意两期之间淋巴结转移率和结外侵犯率比较差异无统计学意义。⑤原发灶主要位于梨状窝者和梨状窝外者的颈部淋巴结转移率和结外侵犯率比较均差异无统计学意义。⑥原发灶侵犯颈段食管与否的颈部淋巴结转移率和结外侵犯率比较均差异无统计学意义。⑦N1、N2、N3任意两期之间转移淋巴结结外侵犯率比较差异无统计学意义。⑧临床Ⅰ+Ⅱ+Ⅲ期组与Ⅳ期组及Ⅱ与Ⅳ期淋巴结转移率比较均差异有统计学意义;临床Ⅲ、Ⅳ期转移淋巴结结外侵犯率比较差异无统计学意义。结论:下咽癌颈淋巴结转移主要分布在Ⅱ、Ⅲ、Ⅳ区,以Ⅱ区最多。T分期、原发灶部位与颈淋巴结转移率和结外侵犯率无关,原发灶侵犯食管颈段并不增加颈部淋巴结转移率和结外侵犯率。N分期增高不增加转移淋巴结结外侵犯率。Ⅳ期颈淋巴结转移率明显增加。
Objective: To study the clinical rules of cervical lymph node metastasis of hypopharyngeal carcinoma and to assist the treatment of hypopharyngeal carcinoma. Methods: A retrospective analysis of 45 cases of hypopharyngeal carcinoma of the cervical lymph node dissection, analysis of cervical lymph node metastasis and extranodal invasion and clinicopathological factors. Results ① The neck lymph node metastasis rate was 75.56% in 45 cases of hypopharyngeal carcinoma, 5 cases (11.11%) in 10 cases of bilateral hypopharyngeal carcinoma were bilateral metastasis, and 2 cases (4.44%) were unilateral metastasis. The extranodal metastasis rate of metastatic lymph nodes (79.41%), two cases (5.88%) were bilateral bilateral bilateral extranodal invasion, and two cases (5.88%) bilateral bilateral unilateral tuberculosis. There were 411 clear lymph nodes, 163 lymph node metastases, and 39.66% metastatic lymph nodes in 45 cases. The proportions of metastatic lymph nodes in Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ regions were 0.61%, 49.08%, 25.77%, 21.47% and 3.07% The metastasis rates in each district were 3.57%, 62.02%, 37.17%, 42.17% and 8.62% respectively. ③ The differences ofⅠ + Ⅴ, Ⅱ + Ⅲ + Ⅳ were statistically significant, while there was no significant difference between Ⅰ and Ⅴ; Ⅳ, Ⅳ and Ⅳ were significantly different between the two groups. There was significant difference between Ⅱ and Ⅲ + Ⅳ. There was significant difference between Ⅱ and Ⅲ. There was significant difference between Ⅱ and Ⅳ. There was no significant difference between Ⅲ and Ⅳ. There were significant differences between Ⅰ, Ⅴ and Ⅱ, Ⅲ, Ⅳ, Ⅱ + Ⅲ + Ⅳ respectively. There was no significant difference in the rates of lymph node metastasis and extranodal invasion between T1 + T2 and T3 + T4 and between T1, T2, T3 and T4. ⑤No significant difference was found in the rates of cervical lymph node metastasis and extranodal invasion between the patients with primary foci and pear-shaped foci. ⑥ primary neck lesions of the cervical esophagus or not, cervical lymph node metastasis rate and extranodal invasion were no significant difference. ⑦N1, N2, N3 between any two stages of metastatic lymph node metastasis rate was no significant difference. ⑧ clinical Ⅰ + Ⅱ + Ⅲ group and Ⅳ group and Ⅱ and Ⅳ lymph node metastasis rates were statistically significant differences; Ⅲ, Ⅳ clinical lymph node metastasis rate was no significant difference. Conclusion: The cervical lymph node metastasis of hypopharyngeal carcinoma is mainly distributed in Ⅱ, Ⅲ, Ⅳ area, and Ⅱ area is the most. T staging, the site of primary tumor and cervical lymph node metastasis rate and extranodal invasion rate has nothing to do, the primary tumor invasion of esophageal cervical segment does not increase the rate of cervical lymph node metastasis and extranodal invasion. N staging does not increase the rate of extranodal metastasis of metastatic lymph nodes. Ⅳ cervical lymph node metastasis rate increased significantly.