作者单位:100730 北京,中国医学科学院协和医科大学北京协

    和医院耳鼻咽喉头颈外科

    通讯作者:魏伯俊,Email : weibojun1015 @vip. sina. com

    ·临床研究·

    头颈部恶性肿瘤咽后间隙淋巴转移的

    诊断和手术治疗

    魏伯俊 申虹 祝小莉 张宝泉 彭培宏 师秀珍

    【摘要】 目的 探讨头颈部恶性肿瘤咽后间隙淋巴转移的临床表现、 手术方法及其疗效。方法

    总结伴咽后间隙淋巴结肿大的 6 例头颈恶性肿瘤患者的临床表现。其中 ,声门上型喉癌( T3N2M0)

    2 例(高、 中分化鳞癌各 1 例) 、 下咽中分化鳞癌( T3N2M0) 、 口咽中分化鳞癌( T2N2M0) 、 鼻腔恶性黑

    色素瘤( TXN2M0)及甲状腺乳头状癌( TXN2M0)各1 例。由 CT和(或) MRI影像测得咽后间隙肿大

    淋巴结的直径为1. 5～2. 5 cm. 在控制原发灶和颈部转移淋巴结的基础上行咽后间隙淋巴清扫 ,并单

    独送病理检查。结果 6 例咽后间隙清扫标本均见转移 ,均为单发。其中 1/ 2 者 4 例 ,1/ 3 者 2 例 ,且

    均伴颈内静脉链淋巴转移 ,分别为 3/ 15 ,3/ 17 ,4/ 19 ,5/ 19 ,6/ 20 和 6/ 23。无颅神经损伤和咽瘘发生。

    下咽癌患者 2 年后死于肺转移;鼻腔恶性黑色素瘤者第 3 次手术后 14 个月复查时无复发 ,后失访;口

    咽癌患者术后 18 个月局部复发 , 2 年后死亡。其余 3 例患者随访 2～4 年均无瘤生存。结论

    CT和 MRI是诊断咽后间隙淋巴转移的主要手段 ,该处淋巴清扫是比较安全的。

    【关键词】 头颈部肿瘤; 淋巴转移; 颈淋巴结清扫术; 咽后间隙

    Diagnosis and surgical management of metastatic diseases in retropharyngeal space W EI B o2j un ,S H EN Hong , Z HU Xiao2l i , Z HA N G B ao2quan , P EN G Pei2hong , S HI Xi u2z hen. Department of

    Otorhinolary ngolog y Head and Neck , Peking Union Medical Col lege Hos pi tal , Bei j ing 100730 ,China

    Corres ponding author : W EI B o2j un , Emai l : weiboj un1015 @vi p . sina. com

    【Abstract】 Objective To evaluate the symptoms and surgical mangement result s of metastatic

    disease in the ret ropharyngeal space. Methods Six patient s with malignant tumors were collected , in

    which enlarged lymphy nodes presented both in neck and ret ropharyngeal space. They consisted of two

    supraglot tic carcinoma ( T3N2M0 ) , one thyroid carcinoma ( TXN2M0 ) , one nasal melanoma

    ( TXN2M0) , one oropharyngeal carcinoma ( T2N2M0) and one hypopharyngeal carcinoma ( T3N2M0) .

    The enlarged nodes in the ret ropharyngeal space were measured with CT and (or) MRI , which ranged

    f rom 1. 5～2. 5 cm in diameter. Based on the cont rol of the primary and neck disease , the mass in the

    ret ropharyngeal space was dissected and sent for pathologic exam separately. Results Metastasis in

    the ret ropharyngeal space was pathologically proved in all of them , along with the involved internal

    jugular lymphnodes of 3/ 15 , 3/ 17 , 4/ 19 , 5/ 19 , 6/ 20 , and 6/ 23 , respectively. No serious

    complications occurred , such as fistula and cent ral nerve damage. The patient with hypopharyngeal

    carcinoma died of lung metastasis 2 years af ter operation. The one suffering nasal malignant melanoma

    was out of follow2up in the 14th months. The patient with oropharyngeal carcinoma locally relapsed in

    the 18th months and died at the 24th months postoperatively. The rest was alive with tumor f ree

    within the follow2up period f rom 2 to 4 years. Conclusions CT or MRI are the mainstay of diagonosis

    of the metastatic disease in the ret ropharyngeal space and can be surgically cont rolled with safety.

    【K ey words】 Head and neck neoplasms ; Lymphatic metastasis ; Radical neck dissection ;

    Ret ropharyngeal space

    头颈部恶性肿瘤易发生颈淋巴转移 ,转移淋巴

    结控制与否直接影响肿瘤的疗效。常规颈淋巴清扫

    不包括咽后间隙淋巴结 ......