功能性与根治性颈淋巴清扫术在早期口腔鳞状细胞癌治疗中的疗效比较

Comparative study of functional neck dissection and radical neck dissection for early oral squamous cell carcinoma

目的 :探讨功能性颈淋巴清扫术(functional neck dissection,FND)与根治性颈淋巴清扫术(radical neck dissection,RND)在口腔鳞状细胞癌中的临床疗效。方法 :63例口腔鳞状细胞癌患者,分为FND组(n=30)和RND组(n=33),FND组保留胸锁乳突肌、副神经、颈内静脉及耳大神经,术后随访2组患者的肩外展功能、耳大神经功能、颈部是否明显凹陷及颈部复发率。应用SPSS18.0软件包对数据进行单因素χ~2检验、两独立样本均数t检验,以及Fisher确切概率检验。结果 :FND与RND组之间在年龄、性别、肿瘤部位、T分期、N分期、组织学分化程度、病理学类型、术前化疗及术后化疗等方面无显著差异(P>0.05)。所有患者均为N0或N1期,FND组术后肩关节活动度、耳垂感觉麻木及颈部凹陷改善程度显著优于RND组(P<0.05);术后随访2年,FND组的颈部复发率与RND组无显著差异(P=1.000)。结论 :对于N0或N1期口腔鳞状细胞癌患者,FND与RND相比,患者颈部复发率无显著差异,但其并发症显著减少,可明显提高患者术后的生活质量。

PURPOSE： To evaluate the clinical effects of functional neck dissection（FND） and radical neck dissection（RND） on early oral squamous cell carcinoma （OSCC）. METHODS： A total of 63 OSCC patients were divides into 2 groups. Patients in FND group （n =30） underwent functional neck dissection with preservation of sternocleidomastoid muscle, accessory nerve, internal jugular vein and great auricular nerve, while patients in RND group （n=33） underwent radical neck dissection. The follow-up data included movement of shoulder joint, great auricular nerve function, neck shape and local recurrent rate. SPSS 18.0 software package was used for data. RESULTS： There was no significant difference in age, gender, tumor location, T stage, N stage, histologic grades, pathological type, preoperative chemotherapy and postoperative chemotherapy between the two groups（P〉0.05）. Cervical lymph nodes was not palpable（N0） or the diameter was less than or equal to 3cm （N1） for all patients. Compared to RND, the activities of shoulder joint point, earlobe numbness and neck concave deformity were significantly improved with FND （P〈0.05）. Patients were followed up for 2 years, no significant difference was observed for neck recurrence between the two groups （P=1.000）. CONCLUSIONS： FND can be safely performed in cN0 or cNl OSCC patients, which avoids major complications with RND, and improves postoperative quality of life for OSCC patients with NO or N1 stage.