Wen Feng, Zhang Weiwei, Cong Tiechuan, Shen Hong, Qin Yong, Xiao Shuifang, Zhao Enmin
Department of Otorhinolaryngology Head and Neck Surgery，Peking University First Hospital，Beijing，100034，China.
Department of Otorhinolaryngology Head and Neck Surgery，Beijing Luhe Hospital，Capital Medical University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec;34(12):1115-1120. doi: 10.13201/j.issn.2096-7993.2020.12.014.
To summarize and analyze the clinical diagnosis and surgical treatment of patients with tumors involving the root of neck. We retrospectively analyzed the clinical data of 73 patients with tumors involving the root of neck in Peking University First Hospital Otorhinolaryngology Head and Neck Surgery department. Data collected included clinical manifestations, preoperative imaging evaluation, surgical approach selection, postoperative pathological types, postoperative complications and prognosis. The most frequent symptom was a painless cervical mass（36 cases） and dysphagia（16 cases）. All patients underwent preoperative enhanced CT scan or MRI, which would be helpful to evaluate the tumor size, shape, location, relationship with surrounding structures, especially important blood vessels, and secondary changes. The postoperative pathological diagnosis included 37 cases of benign and 36 cases of malignant. The most common benign tumor was retrosternal goiter in 17 cases, and the most common malignant tumor was cervical esophageal cancer in 15 cases. Nonsurgical treatment was performed in 3 cases ,while surgical treatment was performed in 70 cases, including 61 cases （87.1%） with cervical approach , 9 cases （12.9%） with combined cervicothoracic approach , 67 cases of complete tumor resection and 3 cases of palliative resection. Sixteen cases cooperated with thoracic surgerons, and 1 case with orthopedic surgerons. Surgical complications occurred in 16 cases （22.9%）. Seven patients were lost to follow-up, and 66 patients were followed up for 3 months to 15 years. None of the 35 patients with benign tumors had recurrence, and among the 31 patients with malignant tumors, the 3-year survival rate was 48.4% and the 5-year survival rate was 32.3%. Tumors involving the root of neck are challenging to diagnose and treat due to the complex regional anatomy and a variety of pathological types, with comparable proportion of benign and malignant tumors. Surgery is the first choice, but it requires careful preoperative assessment. Surgical approaches include cervical approach and combined cervicothoracic approach, which should be determined according to the pathology, size and surrounding structure of the tumor, as well as the habits of the surgeon. Most benign tumors can be excised by the cervical approach. The combined cervicothoracic approach is suitable for malignant tumors with unclear boundaries and close adhesion of important blood vessels and nerves. Proper treatment of large vessels is the key to complete resection of tumors. There are many complications in the operation of this site, so it is necessary to fully communicate with the patient before operation, and sometimes multidisciplinary cooperation is needed.
总结分析累及颈根部肿瘤患者的临床诊断及外科治疗情况。我们回顾性分析了北京大学第一医院耳鼻咽喉头颈外科73例累及颈根部肿瘤患者的临床资料。收集的数据包括临床表现、术前影像学评估、手术入路选择、术后病理类型、术后并发症及预后情况。最常见的症状是无痛性颈部肿块（36例）和吞咽困难（16例）。所有患者均接受了术前增强CT扫描或MRI检查，这有助于评估肿瘤的大小、形态、位置、与周围结构尤其是重要血管的关系以及继发改变。术后病理诊断良性37例，恶性36例。最常见的良性肿瘤是胸骨后甲状腺肿17例，最常见的恶性肿瘤是颈段食管癌15例。3例患者接受非手术治疗，70例患者接受手术治疗，其中经颈部入路61例（87.1%），经颈胸联合入路9例（12.9%），肿瘤完整切除67例，姑息性切除3例。16例患者与胸外科合作，1例患者与骨科合作。手术并发症发生16例（22.9%）。7例患者失访，66例患者随访3个月至15年。35例良性肿瘤患者均无复发，31例恶性肿瘤患者中，3年生存率为48.4%，5年生存率为32.3%。由于该区域解剖结构复杂且病理类型多样，累及颈根部的肿瘤诊断和治疗具有挑战性，良性和恶性肿瘤比例相当。手术是首选，但需要仔细的术前评估。手术入路包括颈部入路和颈胸联合入路，应根据肿瘤的病理、大小、周围结构以及术者习惯来确定。大多数良性肿瘤可经颈部入路切除。颈胸联合入路适用于边界不清且重要血管神经粘连紧密的恶性肿瘤。妥善处理大血管是肿瘤完整切除的关键。该部位手术并发症较多，因此术前需与患者充分沟通，有时还需要多学科协作。
