功能性和肩胛舌骨肌上颈淋巴结清扫术治疗cN0/N1期口腔鳞癌的效果比较

Functional and supraomohyoid neck dissection in stage cN0/N1 oral squamous cell carcinoma

目的探讨功能性颈淋巴结清扫术(FND)与肩胛舌骨肌上颈淋巴结清扫术(SOND)在cN0/N1期口腔鳞状细胞癌中的临床疗效。方法回顾性分析。青岛大学附属医院口腔颌面外科2012年1月至2015年5月期间收治的行颈淋巴结清扫术的口腔鳞状细胞癌患者共计210例,其中男147例,女63例,年龄23~82(62.2±10.2)岁,行FND112例(FND组),行SOND98例(SOND组)。随访两组患者的颈部淋巴结转移情况、肩外展功能、耳大神经功能、颈部复发率,并进行比较分析。结果FND与SOND两组间在性别、年龄、肿瘤部位、T分期、N分期、组织学分化程度方面差异均无统计学意义(均P>0.05)。术后随访结果显示,SOND组术后肩关节活动度、耳垂感觉麻木情况优于FND组;210例患者中颈部复发17例,占8.1%,其中FND组9例(8.0%),SOND组8例(8.2%),两组比较差异无统计学意义(P=0.973)。结论对于cN0/N1期口腔鳞状细胞癌患者,与FND相比,行SOND的患者颈部复发率相似,但其并发症减少,可明显提高患者术后生活质量。

Objective To evaluate the clinical effects of functional neck dissection (FND) and supraomohyoid neck dissection (SOND) in patients with cN0/N1 oral squamous cell carcinoma (OSCC). Methods A total of 210 patients with stage cN0/N1 OSCC underwent FND and SOND between January 2012 and May 2015 were retrospectively reviewed, among which, 147 patients were male and 63 were female, with an age range of 23-82 years and mean age of (62.2±10.2) years. There were 112 and 98 patients in FND and SOND groups, respectively. The follow-up data included cervical lymph node metastasis, movement of shoulder joint, great auricular nerve function, recurrence rate of cervical lymph nodes. Results There was no significant difference in gender, age, tumor location, T stage, N stage, histological grades between the two groups (all P>0.05). Compared to patients in FND group, the activities of shoulder joint and earlobe numbness improved significantly in SOND group. Of the 210 patients, 17 patients (8.1%) had cervical recurrence, with 9 patients (8.0%) in FND group and 8 patients (8.2%) in SOND group. No significant difference was observed for neck recurrence between the two groups (P=0.973). Conclusion SOND can be safely performed in cN0 or cN1 OSCC patients, which avoids major complications of FND, and improves postoperative quality of life in those patients.