早期口腔癌扩大切除颈部淋巴结处理的回顾性研究

Clinical follow up of neck lymph node for patients with early stage oral cancer treated with simply primary lesion resection

目的探讨早期口腔癌扩大切除颈部淋巴结观察的临床疗效。方法收集45例早期口腔癌患者,男性20例,女性25例,其中舌癌18例,下颌牙龈癌8例,上颌牙龈癌7例,口底癌6例,颊癌3例,软腭癌3例。对本组患者均采用原发灶外1cm扩大切除术,不同期行颈淋巴结清扫术,术后对患者进行严密随访,最长5年,最短1年。结果 3例患者1年后失访。在随访期内有1例舌癌患者扩大切除原发灶后2个月复发,41例患者随访期内原发灶控制良好。有6例舌癌患者,术后3个月内出现颈部以及颌下出现肿大的淋巴结,并且伴有疼痛,1例下颌牙龈癌的患者术后6个月出现颌下淋巴结肿大,均行治疗性颈清术,病理证实均为颈部转移淋巴结,其余35例患者在随访期内颈部淋巴结未见明显异常。结论早期口腔癌患者可以单纯行原发灶扩大切除术,术后进行密切随访,如有颈部肿大淋巴结,应给予积极的手术治疗。

Objective To investigate the clinical outcome of cervical lymph node after simply extended primary lesion resection for early stage oral cancer.Methods Forty-five patients with early stage oral cancer,including 18 cases of tongue cancer,8 cases of mandibular and 7 maxillary gingival cancer,6 cases of oral floor cancer,3 cases of buccal cancer,3 cases cancer of soft palate.All the patients were treated with extended resection of primary lesions without concurrent neck dissection.The patients were followed up for one to five years after operation.Results The follow-up failed in three patients.One patient with tongue cancer had a relapse 2 months after operation.Forty one patients obtained excellent control of primary lesion.Six patients with tongue cancer had lymphadenopathy in neck and submandibular region accompanied with pain 3 months after operation.One patient with mandibular gingival cancer had a lymphadenopathy in submandibular region 6 months after operation.All these 7 patients underwent radical neck dissection and metastasis was confirmed.No abnormalities of neck lymph nodes were found in the other 35 patients.Conclusion Early stage oral cancer can be treated with simply extended resection of primary lesions with close follow up of cervical lymph node.Lymphoadenopathy once found in neck should be treated with surgical procedure actively.