不同声门型喉癌喉前淋巴结转移的研究

发布时间：2018-01-23 02:41

  本文关键词： 声门型喉癌 喉前淋巴结 转移　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:喉前淋巴结转移作为喉癌预后不良的重要指标被广泛提出,本文通过回顾性病例分析,探讨不同声门型喉癌喉前淋巴结转移的规律,为喉癌规范手术提供依据。方法:对安徽医科大学第一附属医院2005年1月至2014年6月收治的92例声门型喉癌进行回顾性分析,其中男性病人90名,女性病人2人,年龄在42-77岁之间,平均年龄为56.8岁。该92例声门型喉癌在行不同手术时,皆常规行喉前淋巴结清扫,采集到有效的喉前淋巴组织送检。比较喉前淋巴结阴性组及阳性组在肿瘤分期、病理分型、术后颈部淋巴结复发和局部复发、生存时间之间的差异。结果:92例病例中喉前淋巴结阳性者5例,发生率为5.4%(5/92),5例喉前淋巴结阳性者均为T3病变。本组早期喉癌(Ⅰ期、Ⅱ期)未见喉前淋巴结转移,而中晚期喉癌(Ⅲ期、Ⅳ期)喉前淋巴结发生转移率较高,为15.2%(5/33),卡方=6.73,P0.01,差异有统计学意义,晚期喉癌(Ⅲ期、Ⅳ期)较早期(Ⅰ期、Ⅱ期)的喉前淋巴结更容易发生转移。92例喉鳞状细胞癌的病理为:高分化41例,中分化40例,低分化11例;伴喉前淋巴结转移的高分化鳞癌2例,占4.88%(2/41),中、低分化3例,占5.88%(3/51),卡方=0.06,p0.05,差异无统计学意义,故喉前淋巴结转移与病理分型差异无统计学意义。无喉前淋巴结转移的喉癌即喉前淋巴结阴性组术后颈部发生颈部淋巴结复发者2.30%(2/87),而喉前淋巴结转移的喉癌即喉前淋巴结阳性组术后颈部淋巴结复发为40%(2/5),较阴性高,卡方=8.37(p0.01),故喉前淋巴结转移阳性组术后发生颈部淋巴结复发较阴性组高,差异有统计学意义。无喉前淋巴结转移的喉癌即喉前淋巴结阴性组术后局部复发为12.6%(11/87),而喉前淋巴结转移的喉癌即喉前淋巴结阳性组术后局部复发者占60%(3/5),较前者高,卡方=4.96,(0.01p0.05),故喉前淋巴结转移阳性组术后局部复发较阴性组高,差异有统计学意义。喉前淋巴结阳性者5例,平均生存时间31.33月,标准误6.27月,95%CI:19.04月~43.62月,中位生存时间19.00个月。喉前淋巴结阴性者87例,平均生存时间51.97月,标准误1.76月,95%CI:48.52月~55.43月,中位生存时间60.00个月,卡方=21.36,p0.01,故喉前淋巴结阴性组较阳性组生存时间长,差异有统计学意义。结论:喉前淋巴结在晚期声门型喉癌中发生转移率较高,对于晚期喉癌应常规行喉前淋巴结清扫;喉前淋巴结一旦转移,其颈部和局部复发的机率增加,预后较差,对于伴发喉前淋巴结转移的晚期喉癌应在规范的手术基础上,高度重视术后的继续治疗。
[Abstract]:Objective: prelaryngeal lymph node metastasis as an important indicator of poor prognosis of laryngeal carcinoma has been widely proposed. Through retrospective analysis of cases, the regularity of laryngeal lymph node metastasis in different glottic laryngeal carcinoma was discussed. Methods: 92 cases of glottic laryngeal carcinoma treated in the first affiliated Hospital of Anhui Medical University from January 2005 to June 2014 were analyzed retrospectively. There were 90 male patients and 2 female patients, aged between 42 and 77 years, with an average age of 56.8 years. The 92 patients with glottic laryngeal carcinoma underwent routine anterior laryngeal lymph node dissection. Effective prelaryngeal lymphoid tissues were collected and compared between the negative group and the positive group in tumor staging, pathological classification, postoperative cervical lymph node recurrence and local recurrence. Results among 92 cases, 5 cases were positive for prelaryngeal lymph nodes, the incidence was 5.4% (95 / 92). All the 5 cases with positive prelaryngeal lymph nodes were T3 lesions. There was no metastasis of prelaryngeal lymph nodes in early laryngeal carcinoma (stage 鈪，

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