不同外科手术方式在鼻咽癌放疗后颈淋巴结残留或复发补救治疗中的应用研究

发布时间：2019-03-01 09:00

【摘要】：目的：比较不同外科手术方式对鼻咽癌放疗后颈部淋巴结残留或复发补救治疗疗效的影响，探讨鼻咽癌放疗后颈部淋巴结残留或复发的有效手术方式 方法：回顾性分析102例行外科补救治疗的鼻咽癌放疗后颈淋巴结残留或复发病例，其中全颈清扫术38例,改良性颈清扫术12例,择区性颈清扫术和颈淋巴结切除术各26例。分析残留或复发淋巴结的位置特征及各位置间相互关系，比较4种不同手术方式对疗效的影响，评估术后再次放疗的价值。。 结果：1、102例入组患者外科手术后的5年累积生存率为42.22%,颈淋巴结复发率为24.5%。 2、鼻咽癌放疗后颈淋巴结残留或复发颈淋巴结部位以Ⅱ区为主（54．5％和57．5％），其次是Ⅲ区，而Ⅳ、Ⅴ、Ⅰ区则较少。 3、Ⅲ区和（或）Ⅳ区残留或复发的病例多多伴其他区同时出现，而累及Ⅱ区和Ⅴ区者大都以单独出现者为多。 4、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年累积生存率分别为38.8%、59.2%、37.1%和43.7%,差异无统计学意义(χ2=1.0, P=0.8023),颈淋巴结复发率差异也无统计学意义(χ2=0.460, P=0.482)。 5、颈清扫术后颈部给予与未给予术后再次放疗者的5年累积生存率分别为39.8%和45.8%,差异无统计学意义(χ2=0.06, P=0.8213)。 结论：广泛切除术适应于鼻咽癌放疗后残留和复发颈淋巴结累及一个区以上和（或）直径较大和（或）固定者，其余则采用选择性颈清扫术，必要时术后可行再次放疗。
[Abstract]:Objective: to compare the effects of different surgical methods on residual or recurrent cervical lymph nodes after radiotherapy for nasopharyngeal carcinoma (NPC). Methods: a retrospective analysis of 102 cases of residual or recurrent cervical lymph nodes after radiotherapy was performed in 102 cases of nasopharyngeal carcinoma treated with surgical remedy, of which 38 cases were treated by total neck dissection. There were 12 cases of modified neck dissection, 26 cases of selective neck dissection and 26 cases of neck lymph node resection. To analyze the location characteristics of residual or recurrent lymph nodes and the relationship between each other, to compare the effects of 4 different surgical methods on the curative effect, and to evaluate the value of reradiotherapy after operation. Results: the 5-year survival rate was 42.22% and the recurrence rate of cervical lymph nodes was 24.5% in 1102 patients. 2. Region 鈪，

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