Houck J R, Medina J E
Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City 73190-3048, USA.
Semin Surg Oncol. 1995 May-Jun;11(3):228-39. doi: 10.1002/ssu.2980110308.
Due to the overwhelming prognostic significance of regional metastases, proper management of cervical lymph nodes in cases of squamous cell carcinoma of the head and neck is essential for an optimal outcome. Better understanding of the predictability of incidence and patterns of metastases of these tumors in recent years has led us away from the radical neck dissection as the only surgical therapeutic or staging procedure done on the neck. Recent studies suggest that selective removal of lymph node groups at risk in clinically negative necks, or modified neck dissections that save important structures, like the jugular vein, XI nerve, and sternocleidomastoid muscle, in clinically positive necks, are appropriate in many patients. Careful selection of the type of neck dissection and judicious use of postoperative radiation therapy can optimize cure rates as well as functional and cosmetic results.
由于区域转移具有压倒性的预后意义，对头颈部鳞状细胞癌病例中的颈部淋巴结进行妥善处理对于获得最佳治疗效果至关重要。近年来，对这些肿瘤转移发生率和转移模式可预测性的更好理解，使我们不再将根治性颈清扫术作为颈部唯一的手术治疗或分期程序。最近的研究表明，对于临床阴性颈部有转移风险的淋巴结组进行选择性切除，或者对于临床阳性颈部进行保留重要结构（如颈静脉、XI神经和胸锁乳突肌）的改良颈清扫术，对许多患者是合适的。仔细选择颈清扫术的类型并明智地使用术后放射治疗，可以优化治愈率以及功能和美容效果。
