头颈部肉瘤11例临床分析

Clinical analysis of 11 cases of head and neck sarcoma

摘要:

目的 探讨头颈部肉瘤的临床特征、病理分型、治疗方案及预后转归。方法 回顾性分析2018年 9月—2025年4月南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科收治的11例头颈部肉瘤患者的临床资料与随访结果，总结患者的临床表现、手术方案及预后情况。结果 本组11例患者中，男8例，女3例；年龄30~81岁。肿瘤发生部位：颈部5例，声带4例，室带1例，声门旁间隙1例。病理类型：滑膜肉瘤3例，纤维肉瘤3例，软骨肉瘤2例，脂肪肉瘤2例，横纹肌肉瘤1例。主要临床表现：声音嘶哑5例，颈部肿块4例，吞咽困难1例，咽部异物感1例。所有患者均接受手术治疗，其中全喉切除术3例，喉部分切除术4例，颈部肿物切除术4例；6例患者术后接受辅助治疗。随访时间为12~90个月，截至末次随访，11例患者均存活，未出现肿瘤复发。结论 头颈部肉瘤为临床罕见的头颈部恶性肿瘤，完整切除肿瘤并保证切缘阴性是该病治疗的关键。对于病灶局限于喉内或颈部的低、中度恶性肉瘤，可在保障安全切缘要求的前提下实施喉功能保留手术。该病总体预后良好，患者需坚持终身随访。

Abstract:

Objective To investigate the clinical characteristics, pathological types, treatment and prognosis of head and neck sarcoma. Methods The clinical data and follow-up results of 11 patients with head and neck sarcomas admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School from September 2018 to April 2025 were retrospectively analyzed. The clinical manifestations, surgical plans, and prognosis of the patients were summarized. Results Of the 11 patients, 8 were male and 3 were female, with ages ranging from 30 to 81 years old. As for the tumor location, there were 5 cases in the neck, 4 cases in the vocal cord, 1 case in the ventricular fold, and 1 case in the paraglottic space. The pathological types included synovial sarcoma in 3 cases, fibrosarcoma in 3, chondrosarcoma in 2, liposarcoma in 2, rhabdomyosarcoma in 1. The main symptoms included hoarseness in 5 cases, neck mass in 4 cases, dysphagia in 1 case, and pharyngeal foreign body sensation in 1 case. All patients underwent surgical treatment, including total laryngectomy in 3 cases, partial laryngectomy in 4 cases, and neck mass resection in 4 cases. Six patients received postoperative adjuvant radiotherapy and chemotherapy. All patients were followed up for 12 to 90 months. As of the last follow-up, all 11 patients survived with no postoperative recurrence. Conclusions Head and neck sarcoma is rare. Radical surgical resection with negative surgical margins is the key to treatment. For low-to-intermediate grade malignant sarcomas confined to the larynx or neck, laryngeal function-preserving surgery can be performed while meeting the requirements for safe margins. The overall prognosis is favorable, and patients need to undergo long-term and lifelong follow-up.