恶性肿瘤淋巴结转移外科治疗的新趋向(3)
肿瘤治疗中，区域性淋巴结转移的正确处理对提高治愈率有很大影响。20世纪前50年肿瘤外科强调扩大整块切除肿瘤、牺牲器官功能以获取比较高的生存率。到近50年，注意到减少创伤，保全功能，在放疗或化疗等综合治疗条件下，在不影响生存率前提下，缩小手术范围，以保证维持或提高患者治疗后生存质量。患者如已有区域性淋巴结转移，应该手术清扫，必要时加以放射治疗。对于临床判断为N0，但其中有相当比例患者有潜在淋巴结转移者，应该如何处理，有不同见解。从主张全区域淋巴结清扫到局限性清扫，到前哨淋巴结检测，这是一个进步。这是临床肿瘤学的一百年间的一个变化。这是从伦理学考虑的一个概念的变化，也是长期经验和积累资料的实证显示。
参考文献
1. Halsted WS. Operations for carcinoma of the breast. In:Holleb AI and Rander-Pehrson MB. Classics in oncology. Amer Cancer Society, Inc., New York, NY. 1987:109-113
, 百拇医药
2. 王德元 朗义芳.I期乳腺癌手术后的辅助治疗.中国肿瘤临床 1986，13：267-270
3. 俞全兴 郭孝达 殷评等.83例早期胃癌的临床病理分析.中国肿瘤临床 1986，13；131-132
4. 陈峻青，王舒宝，单吉贤等.胃癌淋巴结转移规律研究. 中国肿瘤临床与康复 1999；6：1-4
5. 陈朝伦，卢晓梅，黄绒等。一期癌症患者切除淋巴结内隐匿性微小转移灶的检查及其临床意义.中华肿瘤杂志 1997，19：69-71
6. Crile G.Excision of cancer of the head and neck cancer. JAMA 1906,47:1780-1786
7. Martin H, Del Valle B, Ehrlich H, et al. Neck Dissection. Cancer 1951,4:441-499
, 百拇医药
8. Beahrs, OH, Gossel JD, Hollinshead WH. Technic and surgical anatomy of radical neck dissection. Am J Surg. 1955, 90:490-516
9. Skolnick EM, Tenta LT, Wineinger DM, et al. Preservation of XI cranial nerve in neck dissections. Laryngoscope 1967,77:1304.
10. Bocca E, Pignataro O. A conservative technique in radical neck dissection. Ann Otol Rhinol Laryngol 1967,76:975-988
11. Bocca E, Pignataro O, Oldini C, Cappa C. Functional neck dissection: an evaluation and review of 843 cases. Laryngoscope. 1984;94:942-945
, http://www.100md.com
12. Spiro RH, Gallo O, Shah JP. Selective jugular node dissection in patients with squamous carcinoma of the larynx or pharynx. Am J Surg. 1993;166:399-402
13. Traynor SJ, Cohen JI, Gray J, Andersen PE, Everts EC. Selective neck dissection and the management of the node-positive neck. Am J Surg. 1996;172:654-657.
14. Pellitteri PK, Robbin KT, Neuman T. Expanded application of selective neck dissection with regard to nodal status. Head & Neck 1996;19:260-265.
, 百拇医药
15. Henderson IC, Harris JR, Kinne DW et al. Cancer of the breast. In: DeVita VT, Hellman S and Rosenberg SA. Cancer: principles and practice of Oncology. 3rd Ed. LB Lippincott Company, Philadelphia, 1989, 1197-1268
16. 时曜晞 关超 陈兆林等. 声门上喉癌淋巴结转移临床病理研究. 中华耳鼻咽喉科杂志.1990, 25:234-236
17. Snow GB, Patel P, Leemans CR, Tiwari R. Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol. 1992;249:187-194
, 百拇医药
18. Tu GY. Upper neck (Level II) dissection for N0 neck supraglottic carcinoma. Laryngoscope, 109,467-470
19. Byers RM, Wolf PF, Ballantyne AJ. Rational for elective modified neck dissection. Head and Neck Surg, 1988, 10:160-167
20. Spiro RH, Gallo O, Shah JP. Selective jugular node dissection in patients with squamous carcinoma of the larynx and pharynx. Am J Surg, 1993,166:399-402
21. 张跃，华积德.早期乳癌的哨兵淋巴结勘测性活检.中国肿瘤临床与康复，1999，6：94-95
22. Stanton P.Current status of sentinel node biopsy in breast cancer.Aust N Z J Surg,2000,70:86-87
23. Shoaib T, Soutar DS, Prosser JE, et al. A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head & Neck, 1999,21:728-733, http://www.100md.com(屠规益)
参考文献
1. Halsted WS. Operations for carcinoma of the breast. In:Holleb AI and Rander-Pehrson MB. Classics in oncology. Amer Cancer Society, Inc., New York, NY. 1987:109-113
, 百拇医药
2. 王德元 朗义芳.I期乳腺癌手术后的辅助治疗.中国肿瘤临床 1986，13：267-270
3. 俞全兴 郭孝达 殷评等.83例早期胃癌的临床病理分析.中国肿瘤临床 1986，13；131-132
4. 陈峻青，王舒宝，单吉贤等.胃癌淋巴结转移规律研究. 中国肿瘤临床与康复 1999；6：1-4
5. 陈朝伦，卢晓梅，黄绒等。一期癌症患者切除淋巴结内隐匿性微小转移灶的检查及其临床意义.中华肿瘤杂志 1997，19：69-71
6. Crile G.Excision of cancer of the head and neck cancer. JAMA 1906,47:1780-1786
7. Martin H, Del Valle B, Ehrlich H, et al. Neck Dissection. Cancer 1951,4:441-499
, 百拇医药
8. Beahrs, OH, Gossel JD, Hollinshead WH. Technic and surgical anatomy of radical neck dissection. Am J Surg. 1955, 90:490-516
9. Skolnick EM, Tenta LT, Wineinger DM, et al. Preservation of XI cranial nerve in neck dissections. Laryngoscope 1967,77:1304.
10. Bocca E, Pignataro O. A conservative technique in radical neck dissection. Ann Otol Rhinol Laryngol 1967,76:975-988
11. Bocca E, Pignataro O, Oldini C, Cappa C. Functional neck dissection: an evaluation and review of 843 cases. Laryngoscope. 1984;94:942-945
, http://www.100md.com
12. Spiro RH, Gallo O, Shah JP. Selective jugular node dissection in patients with squamous carcinoma of the larynx or pharynx. Am J Surg. 1993;166:399-402
13. Traynor SJ, Cohen JI, Gray J, Andersen PE, Everts EC. Selective neck dissection and the management of the node-positive neck. Am J Surg. 1996;172:654-657.
14. Pellitteri PK, Robbin KT, Neuman T. Expanded application of selective neck dissection with regard to nodal status. Head & Neck 1996;19:260-265.
, 百拇医药
15. Henderson IC, Harris JR, Kinne DW et al. Cancer of the breast. In: DeVita VT, Hellman S and Rosenberg SA. Cancer: principles and practice of Oncology. 3rd Ed. LB Lippincott Company, Philadelphia, 1989, 1197-1268
16. 时曜晞 关超 陈兆林等. 声门上喉癌淋巴结转移临床病理研究. 中华耳鼻咽喉科杂志.1990, 25:234-236
17. Snow GB, Patel P, Leemans CR, Tiwari R. Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol. 1992;249:187-194
, 百拇医药
18. Tu GY. Upper neck (Level II) dissection for N0 neck supraglottic carcinoma. Laryngoscope, 109,467-470
19. Byers RM, Wolf PF, Ballantyne AJ. Rational for elective modified neck dissection. Head and Neck Surg, 1988, 10:160-167
20. Spiro RH, Gallo O, Shah JP. Selective jugular node dissection in patients with squamous carcinoma of the larynx and pharynx. Am J Surg, 1993,166:399-402
21. 张跃，华积德.早期乳癌的哨兵淋巴结勘测性活检.中国肿瘤临床与康复，1999，6：94-95
22. Stanton P.Current status of sentinel node biopsy in breast cancer.Aust N Z J Surg,2000,70:86-87
23. Shoaib T, Soutar DS, Prosser JE, et al. A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head & Neck, 1999,21:728-733, http://www.100md.com(屠规益)