早期口腔鳞状细胞癌行Ⅱb区颈淋巴清扫术的意义

Significance of neck dissection in Ⅱb area in early oral squamous cell carcinoma

目的:评估临床无颈淋巴结转移(cN0)口腔鳞癌患者Ⅱb区淋巴清扫术的意义。方法:回顾2012年1月-2014年12月期间在上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科治疗的203例cN0口腔鳞癌患者,平均年龄59.7岁(41~79岁),术前均未接受其他治疗;男127例,女76例;舌癌101例,颊癌45例,口底癌30例,牙龈癌19例,其他8例。根据术后病理结果,203例患者的TNM分期为T1或T2,均接受病灶切除+肩胛舌骨上颈淋巴清扫术,其中115例患者接受Ⅱb区淋巴清扫。对接受Ⅱb区淋巴清扫与未接受Ⅱb区淋巴清扫的2组患者数据采用独立样本t检验,分析2组患者的术后并发症(主要是肩胛综合征)发生率、Ⅱb区淋巴结转移率(主要针对未做颈淋巴清扫患者),采用SPSS 22.0软件包、Kaplan-Meier生存分析法评估2组患者的3年总生存率。结果:在接受Ⅱb区淋巴清扫的115例患者中,7例(6.09%)患者术后病理证实Ⅱb区淋巴结转移。术后随访3年,Ⅱb区淋巴清扫组中,83例(72.17%)出现不同程度的肩胛综合征,27例(32.53%)患者通过康复锻炼症状减轻,但仍未完全恢复,Ⅱb区淋巴清扫组患者3年总生存率为86.09%;在未接受Ⅱb区淋巴清扫的88例患者中,4例(4.55%)出现肩胛综合征,术后均通过康复锻炼恢复,Ⅱb区淋巴未清扫组患者3年总生存率为84.09%,2组比较无统计学差异(P>0.05)。结论:cN0口腔鳞癌患者出现Ⅱb区淋巴结转移率较低,因此行肩胛舌骨上颈淋巴清扫术时可选择性清扫Ⅱb区淋巴结,从而保护副神经及其分支不受损伤,提高患者术后生活质量。

PURPOSE:To evaluate the clinical significance of selective cervical lymph node dissection in patients with oral squamous cell carcinoma without clinically cervical lymph node metastasis(cN0).METHODS:Between January2012 and December 2014,203 patients with cN0 who were treated in the Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,the average age was 59.7(range:41-79)years,no other treatment was given before surgery.There were 127 males and 76 females.The primary sites were as followed:101 in the tongue,45 in the cheek,30 in the floor of mouth,19 in the gingiva,and 8 in other sites.According to postoperative pathological results,203 patients were classified as T1 or T2,and all underwent primary lesion resection and supraomohyoid neck dissection(SOHND).One hundred and fifteen patients underwentⅡb level lymph node dissection,and the remaining 88 patients did not receiveⅡb level lymph node dissection.The data of the two groups of patients were analyzed by independent sample t test with SPSS 22.0 software package.The analyzed indicators included incidence of complications(mainly scapular syndrome)andⅡb lymph node metastasis rate(mainly for the preservingⅡb group).Survival analysis was estimated by Kaplan-Meier method.RESULTS:In theⅡb level lymph node dissection group,7(6.09%)patients were confirmed by postoperative pathology to have lymph node metastasis in theⅡb area.After3 years of follow-up,83(72.17%)patients had different degrees of scapular syndrome,and 27(32.53%)patients were relieved by rehabilitation training,but still not fully recovered.The 3-year overall survival of patients inⅡb level lymph node dissection group for 86.09%;in the control group,4 patients(4.55%)developed scapular syndrome and recovered through rehabilitation after operation.The 3-year overall survival rate of the patients in the control group was 84.09%.There was no significant difference between the two groups(P>0.05).CONCLUSIONS:Patients with cN0 oral squamous cell carcinoma have a lower rate of cervical lymph node metastasis in the IIb level.Therefore,it is not necessary to excise the lymph nodes in theⅡb area when SOHND is performed,in order to protect the accessory nerve and its branches from damaging and improving the quality of life of the patients.