舌癌颈淋巴清扫术不同术式的疗效

Treatment outcomes of different neck dissection on carcinoma of tongue

目的 分析舌癌不同颈淋巴清扫术式的疗效 ,为舌癌颈淋巴清扫术式的选择提供参考。方法 对3 42例舌癌患者进行回顾性研究 ,观察颈淋巴清扫术不同术式的疗效 ,结果进行 χ2 检验。结果 治疗性颈清术 2 12例 (2 2 2侧 ) ,选择性颈清术 13 0例 (13 3侧 )。经 3年随访 ,舌癌根治性颈清术、改良根治性颈清术、功能性颈清术、非连续性根治性颈清术和舌骨上清扫术术后颈部淋巴结复发率分别为 4.8%、7.3 %、0、13 .6%和 40 .0 % ,舌骨上清扫术术后复发率显著高于其他术式 (P <0 .0 5 ) ,其余各组相比无统计学意义。结论 选择性颈清术术后近 1/4病理证实有转移 ,对于T2 期以上患者应考虑选择性颈清扫术。舌骨上清扫术的术后颈部复发率明显高于其他术式 ,临床上应摒弃此术式 ;改良根治性颈清术既可减少术后并发症、提高生存质量 。

Objective The aim of the study was to evaluate the efficacy of different neck dissection on carcinoma of tongue. Methods A retrospective review of a total 342 patients with carcinoma of tongue who were treated at dental hospital affiliated to West China University of Medical Sciences was undertaken. The patients were followed up to observe neck recurrence of different neck treatment. The results were analyzed by using χ 2 analysis. Results In 342 patients, 212 patients were performed therapeutic neck dissection, another 130 patients were performed elective neck dissection. The patients received suprahyoid neck dissection had highest neck recurrence (40%), the patients received non- monobloc resection had higher neck recurrence ( 13.64 %). The incidence of neck recurrence after radical neck dissection (RND) and modified radical neck dissection(MRND) was 4.83 % and 7.27 %. No patient who underwent functional neck dissection had neck recurrence. Lymph node pathologic positive rate increased with clinical T and N classification. Conclusion TNM classification is useful to estimate lymph metastasis. Selective neck dissection should be considered for patients beyond T 2 classification. Suprahyoid neck dissection should be abandoned because of high recurrence. MRND not only preserve some important function and reduce complication but also have a good neck control.