舌活动部鳞癌颈淋巴结阴性(cN_0)的处理

Management of cervical lymph node negative(cN_0) on patients with squamous cell carcinoma of oral tongue

目的 :通过分析舌活动部鳞癌病人临床检查颈淋巴结阴性 (c N0 )的隐匿性淋巴结转移在颈部各区的分布 ,显示舌活动部鳞癌的淋巴结转移规律 ,并指导舌活动部鳞癌 c N0 的分区性颈淋巴清扫的范围。方法 :回顾分析 33例 c N0 的舌活动部鳞癌行选择性全颈淋巴结清扫和挽救性颈淋巴结清扫术的病例 ,分析手术后病理阳性淋巴结 (p N+ )在颈部各区的分布。结果 :病理证实单个淋巴结转移 14例 ,其中 区淋巴结转移 3例 , 区淋巴结转移 7例 , 区淋巴结转移 4例 , 区和 区未见淋巴结转移。多个淋巴结转移 19例 ,各区转移频率分别为 : 区 2 7.4 5 % ; 区 39.2 2 % ; 区31.37% ; 区 0 % ; 区 1.96 %。结论 :舌活动部鳞癌 c N0 的颈部处理没有必要采用经典性全颈清扫术 ,建议行肩胛舌骨肌上的分区性清扫 ,即 区清扫 + 区清扫 + 区清扫即可 ,避免全颈清术给患者造成的术后损害。

Objective:To find out the management principle of cervical lymph node negative(cN 0 ) on patients with squamous cell carcinoma of oral tongue.Methods:One hundred and eighteen patients with squamous cell carcinoma of oral tongue and cN 0 were treated by surgery in our department from 1966 to 1995.There were 77 males and 41 females,ranging in age from 26 to 72 years old.Among 118 patients,33 cases were T 1N 0(27 97%,33/118),52 were T 2N 0(44 07%,52/118),24 were T 3N 0(20.34%,24/118),9 were T 4N 0(7.63%,9/118).The radical total neck dissection was completed in all 118 cases.Results:The lymphatic metastasis was found in 33 of 118 cases (27.97%),which 25 were found in postoperative cervical node pathologic positive and 8 were found during the period of 5 years follow\|up .Among these 33 patients,the clinical stage was 5 in T 1N 0,17 in T 2N 0,7 in T 3N 0 and 4 in T 4N 0.And 14 cases were single lymph node metastases (3 in level Ⅰ,7 in level Ⅱ,4 in level Ⅲ)and 19 were many lymph node metastases(1 in level Ⅰ,2 in level Ⅱ,2 in level Ⅲ,4 in level Ⅰ+Ⅱ,3 in level Ⅰ+Ⅲ,4 in level Ⅱ+Ⅲ,2 in level Ⅰ+Ⅱ+Ⅲ,1 in level Ⅰ+Ⅱ+Ⅲ+Ⅴ).The positive rate of lymphatic metastasis was 27.45%(14/51) in level Ⅰ,39.22%(20/51) in level Ⅱ,31.37%(16/51) in level Ⅲ,0.0% in level Ⅳ and 1.96%(1/51) in level Ⅴ respectively.The survival rate of 5\|year was 44.0%(11/25) in the group of selective neck dissection and 37.5(3/8) in the group of salvage neck dissection.Conclusion:It was not necessary to adopt the typical total neck dissection for patients with cN 0 of oral tongue squamous cell carcinoma.In order to avoid the surplas postoperative damage to the patients after total neck dissection ,a selective neck dissection in the region above omohyoid muscle was recommended as enough.