口腔黏膜鳞状细胞癌颈Ⅱ区连续整块切除临床意义探讨

The clinical significance of continuous and en bloc resection in level Ⅱ

目的探讨口腔黏膜鳞状细胞癌颈Ⅱ区连续整块切除的意义。方法选取安徽医科大学附属省立医院口腔医学中心颌面头颈外科1999年1月至2004年1月期间行颈清扫术且病例记录及术后随访资料完整的117例病例,以颈Ⅱ区连续整块切除与否为指标,观察根治性颈清扫术(RND)和功能性颈清扫术(FND)两种术式的术后颈部淋巴结复发率。结果117例病例中,术后病理诊断为淋巴结转移癌32例,转移率为27.35%(32/117),其中RND26例,FND6例。经3年期随访,颈清扫术后淋巴结复发18例,复发率为15.38%,其中RND12例,FND6例。位于Ⅱ区淋巴结复发有15例,占83.33%,其中RND9例,FND6例。结论对FND应有严格的指征,确定癌肿病例的生存质量必定建立于肿瘤控制的基础上,得出肿瘤不能根治则谈不上生存质量的结论,建议提倡施行保留胸锁乳突肌(必要时加副神经)的FND术式。

Objective To explore the clinical significance in continuous and en bloc resection in level Ⅱ.Methods Cervical lymph node recurrence rates of two operative methods were observed according to the comparison of level Ⅱwith and without continuous and en bloc resection.Results Postoperative pathology showed the metastasis rate was 27.35%(32/117),the recurrent rate was 15.38%(18/117)after following visits for three years,the lymph node recurrence rates located at level Ⅱ was 83.33%(15/18),in which FND was 100%(6/6).Conclusion There are strict conditions for FND,and life quality of cancer patients are definitely based on the control of recurrent tumors.Without radical resection of tumor,quality of life would not exist.Therefore,this study advocates the method of FND which preserves sternocleidomastoid muscle(and accessory nerve if necessary).