Hosal A S, Carrau R L, Johnson J T, Myers E N
Department of Otolaryngology--Head and Neck Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
Laryngoscope. 2000 Dec;110(12):2037-40. doi: 10.1097/00005537-200012000-00011.
To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node-negative neck.
Case histories were evaluated retrospectively.
The results of 300 neck dissections performed on 210 patients were studied.
The primary sites were oral cavity (91), oropharynx (30), hypopharynx (16), and larynx (73). Seventy-one necks (23%) were node positive on pathological examination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had extracapsular spread. The median follow-up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes were negative on histological examination (3%) when compared with patients with positive nodes without extracapsular spread (4%). In contrast, regional recurrence developed in 18% of necks with extracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pNO) necks in the patients who did not have irradiation.
SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy.
评估选择性颈部清扫术（SND）在临床颈部淋巴结阴性患者治疗中的疗效。
对病例史进行回顾性评估。
研究了对210例患者进行的300例颈部清扫术的结果。
原发部位为口腔（91例）、口咽（30例）、下咽（16例）和喉（73例）。71例颈部（23%）病理检查显示淋巴结阳性。每侧阳性淋巴结数量从1个到9个不等。在淋巴结阳性的颈部中，17例（24%）有包膜外扩散。中位随访时间为41个月。11例患者（4%）清扫的颈部出现疾病复发。2例复发发生在清扫区域外。组织学检查淋巴结阴性的患者（3%）与无包膜外扩散的淋巴结阳性患者（4%）的区域复发率相似。相比之下，有包膜外扩散的颈部区域复发率为18%。这一观察结果具有统计学意义。有两个以上转移淋巴结的患者疾病复发率高于癌灶局限于一两个淋巴结的患者。在未接受放疗的患者中，病理淋巴结阳性（pN+）颈部的复发率与病理淋巴结阴性（pN0）颈部的复发率相当。
选择性颈部清扫术对控制颈部疾病有效，并有助于检测需要辅助治疗的患者。
