Kruk-Zagajewska Aleksandra, Paprzycki Włodzimierz, Gawecki Wojciech, Borucki Łukasz, Banaszewski Jacek
Klinika Otolaryngologii i Onkologii Laryngologicznej UM im. Karola Marcinkowskiego w Poznaniu.
Otolaryngol Pol. 2008;62(3):278-82. doi: 10.1016/S0030-6657(08)70254-3.
Paratracheal lymph nodes receive the lymph from the larynx, hypopharynx, esophagus, thyroid gland and trachea. It is evaluated, that metastases to these nodes occur in about 10-30% of patients with cancer of the larynx, hypopharynx or cervical esophagus. These metastases can lead to the most tragic complication after total laryngectomy, which is the stomal recurrence, Paratracheal lymph nodes are not accessible to examine by palpation or ultrasonography.
The aim of this study was to estimate the usefulness of CT, MRI and clinical intraoperative investigation in the search for enlarged paratracheal lymph nodes.
The investigation was performed in 15 patients with advanced larynx and/or hypopharynx cancer. In all the patients we carried out palpation and ultrasonography of the neck, in 7 cases CT and in another 8 cases MRI of the neck. In all the patients who were operated (14 cases) the exact search for enlarged paratracheal lymph nodes during operation was performed.
Palpation and ultrasonography of the neck did not found any enlarged paratracheal lymph nodes in anybody of the patients. CT showed one enlarged prelaryngeal lymph node in one patient. MRI showed one enlarged pretracheal lymph node in another one patient. During operation we found one enlarged paratracheal lymph node, which was not seen in MRI. All these nodes were pathologically not metastatic.
The analysis of the state of paratracheal lymph nodes is very important in prophylaxis of stomal recurrence after total laryngectomy. However preoperative estimation of these nodes is very difficult and limited. It seems to us, that the best way of estimation of the state of paratracheal lymph nodes is intraoperative exploration of the area between trachea and esophagus and excision even loose tissue to pathological examination.
气管旁淋巴结接收来自喉、下咽、食管、甲状腺和气管的淋巴液。据评估，喉癌、下咽癌或颈段食管癌患者中约10%-30%会发生这些淋巴结转移。这些转移可导致全喉切除术后最悲惨的并发症，即造口复发。气管旁淋巴结无法通过触诊或超声检查进行评估。
本研究的目的是评估CT、MRI和临床术中检查在寻找肿大气管旁淋巴结方面的实用性。
对15例晚期喉癌和/或下咽癌患者进行了研究。对所有患者均进行了颈部触诊和超声检查，7例患者进行了颈部CT检查，另外8例患者进行了颈部MRI检查。对所有接受手术的患者（14例）在手术中准确寻找肿大的气管旁淋巴结。
颈部触诊和超声检查未在任何患者中发现肿大的气管旁淋巴结。CT显示1例患者有1个肿大的喉前淋巴结。MRI显示另1例患者有1个肿大的气管前淋巴结。手术中发现1个肿大的气管旁淋巴结，MRI未显示。所有这些淋巴结经病理检查均无转移。
气管旁淋巴结状态分析对全喉切除术后造口复发的预防非常重要。然而，术前对这些淋巴结的评估非常困难且有限。在我们看来，评估气管旁淋巴结状态的最佳方法是术中探查气管与食管之间的区域，甚至切除疏松组织进行病理检查。
