Objective: To investigate the metastatic sequence of cervical lymph node in hypopharyngeal carcinoma aimed at guiding neck exploration. Methods: Seventy-five serial sections of integrally dissected lateral neck specimens from 67 patients of hypophayryngeal carcinoma were histopathologically observed, and the metastatic sequence of cervical lymph node of hypophayryngeal carcinoma were analysed. Results: In 75 integrally dissected lateral neck specimens, 63 laterals were found to occur cervical lymph node metastases, the metastatic ratio was 84.0%. The analytic result of 63 dissected lateral neck specimens with positive lymph nodes showed that the metastatic lymph node ratio in descending order was level Ⅱ (90.5%), level Ⅲ (76.2%), level Ⅳ (41.3%), level Ⅴ (15.9%), level Ⅰ (7.9%) and level Ⅵ (3.2%). The metastatic ratio of lymph node between level Ⅰ~Ⅵ were significantly different from each other (P<0.01). When the tumor metastasized to one cervical lymph node, this could be found in levels Ⅱ or Ⅲ, when metastasized to two cervical lymph nodes, these could be found in levels Ⅱ, Ⅲ, Ⅳ, and when metastasized to more than 5 of cervical lymph nodes, these could be found in levels Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅰand Ⅵ. According to the occurring sequence, metastatic ratio and number of cervical lymph node metastasis (LNM), levels Ⅱ and Ⅲ were identified as the first station, level Ⅳ was the second station and levels Ⅴ, Ⅰ and Ⅵ were the third station of cervical LNM in hypopharyngeal carcinoma. Conclusion: The confirmation of metastatic sequence of cervical lymph node in hypophayryngeal carcinoma provides a reliable evidence for neck lymph node dissection and reference value for clinic therapy.
目的： 探讨下咽癌颈部淋巴结转移的顺序及对颈清扫术的指导意义。 方法： 对67例下咽癌患者的75侧颈清扫整体标本连续切片，进行组织病理学观察，分析下咽癌颈部淋巴结转移顺序。 结果： 75侧颈清扫术整体标本中，淋巴结转移63侧(84.0%)。63侧下咽癌颈部淋巴结转移阳性颈清扫术标本分析的结果显示，淋巴结转移率由高至低依次为Ⅱ区(90.5%)、Ⅲ区(76.2%)、Ⅳ区(41.3%)、Ⅴ区(15.9%)、Ⅰ区(7.9%)和Ⅵ区(3.2%)。Ⅰ～Ⅵ区的淋巴结转移率比较，差异有统计学意义(P<0.01)。当颈部出现1枚淋巴结转移时，淋巴结转移位于Ⅱ、Ⅲ区；当颈部出现2枚淋巴结转移时，淋巴结转移位于Ⅱ、Ⅲ、Ⅳ区；当颈部有≥5枚淋巴结转移时，淋巴结转移位于Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅰ和Ⅵ区。按颈部淋巴结转移出现的先后顺序、颈部淋巴结转移率及颈部各区淋巴结转移数目的分布，可将Ⅱ、Ⅲ区确定为下咽癌颈部淋巴结转移的第1站，Ⅳ区为第2站，Ⅴ、Ⅰ和Ⅵ区为第3站。 结论： 通过下咽癌颈部淋巴结转移站序的确定，为颈清扫手术提供了较为可靠的依据，对临床治疗有一定的参考价值。.
Keywords: Carcinoma, squamous cell; Hypopharyngeal neoplasms; Lymph node metastasis; Neck field.