N0、N1期口腔癌颈淋巴结清扫术式回顾分析

NECK DISSECTION IN PATIENTS WITH ORAL SQUAMOUS CELL CARCINOMA IN N0 OR N1 STAGE:A RETROSPECTIVE CLINICAL ANALYSIS

通过回顾性分析探讨无明确临床转移指征的口腔鳞状细胞癌发生亚临床颈部淋巴结转移的概率及其外科处理的较好术式。根据UICC(1987年 )分类分期标准 ,回顾 2 0 5例淋巴结分期为N0、N1期的口腔癌病例的临床病理资料 ,术后随访 ,了解此类病例发生颈部淋巴结转移的概率以及不同手术方式处理后颈部淋巴结的转归。结果发现 ,转移淋巴结病理检出率为 10 8% (13/12 0 ) ,而不作颈清扫术后淋巴结转移率为 16 5 % (14/85 ) ,N0、N1期无显著差别 ;功能性颈清扫术后淋巴结复发率达 11 9% (5 /4 2 ) ,其中颊癌的复发发生率较高 ;根治性颈清扫术后复发率 6 4% (5 /78) ,多数为对侧颈淋巴结复发。说明口腔癌亚临床转移是不容忽视的问题 ,功能性颈清扫范围在颊癌等部位肿瘤应达到Ⅲ级淋巴结 ,累及对侧的下龈癌等肿瘤应考虑双侧的颈清扫。

To evaluate the incidence of sub clinical neck metastasis and its surgical treatment in patients with oral squamous cell carcinoma (OSCC) without clear evidences for lymph nodes metastasis, a total of 205 patients with OSCC in N0 and N1 stage(UICC 1987′s classification) were included in the study.Their clinical and histopathological files were retrospectively studied and patients were followed up after operation. Histopathological positive lymph nodes were found in 10 8%(13/120) of patients,and postoperative lymph nodes metastasis occurred in 16 5%(14/85) of patients without neck dissections.There were no significant differences between N0 and N1 groups.Neck recurrence occurred in 11 9%(5/42) of patients after functional neck dissections.The rate was higher in patients with bucal lesions.Patients undergoing radical neck dissections also had neck recurrence with an incidence of 6 4%.But most of them occurred on contralateral side. It suggested that subclinical metastasis of OSCC with clinically negative neck lymph nodes could not be neglected.Functional neck dissection should include the lymph nodes of level Ⅲ,especially for cancers located on bucca mucosa and tongue.Bilateral neck dissection is necessary for large primary lesions spreading to the contralateral side.