O'Brien C J, Urist M M
Department of Surgery, University of Alabama at Birmingham 35294.
Aust N Z J Surg. 1987 Aug;57(8):501-9. doi: 10.1111/j.1445-2197.1987.tb01411.x.
Classical radical neck dissection (RND) remains the primary treatment for clinically positive lymph nodes among patients with squamous carcinoma of the upper aerodigestive tract. Recurrence rates following RND range from 20 to 70% depending on the number of nodes involved and the extent of extracapsular spread. Modified radical neck dissection (MRND) is associated with less cosmetic and functional morbidity than RND but, used alone, MRND is only appropriate when clinical neck disease is absent or minimal. Both RND and MRND should be combined with adjuvant postoperative radiotherapy when more than one node is positive or extracapsular spread is present. This approach will significantly decrease regional failure, but may not improve survival because of an increased incidence of distant metastases. MRND is especially useful as an elective procedure to stage the clinically negative neck. A survival benefit from elective neck dissection, however, remains to be demonstrated.
经典根治性颈清扫术（RND）仍是上消化道鳞状细胞癌患者临床阳性淋巴结的主要治疗方法。RND后的复发率在20%至70%之间，具体取决于受累淋巴结的数量和包膜外扩散的程度。改良根治性颈清扫术（MRND）比RND的美容和功能损伤更小，但单独使用时，MRND仅适用于临床颈部疾病不存在或很轻微的情况。当有一个以上淋巴结阳性或存在包膜外扩散时，RND和MRND均应与术后辅助放疗相结合。这种方法将显著降低区域复发率，但由于远处转移发生率增加，可能不会提高生存率。MRND作为对临床阴性颈部进行分期的选择性手术特别有用。然而，选择性颈清扫术的生存获益仍有待证实。
