舌、口底癌的连续性与非连续性颈淋巴清扫术

Discontinuous versus in-continuity neck dissection of squamous cell carcinoma of tongue and floor of the mouth

舌、口底癌约占口腔癌的50%,此区域解剖结构复杂、淋巴回流丰富,容易发生转移。颈淋巴清扫术是控制颈部复发及转移最有效的方法。前哨淋巴结活检和淋巴成像有助于术前判断颈淋巴清扫术的适应证。舌淋巴结与舌、口底癌的复发及转移关系密切。连续性颈淋巴清扫术(in-continuity neck dissection)可以清扫包括舌淋巴结在内的位于舌、口底与颈部中间区域的淋巴回流通道,清扫更为彻底,适用于T2期以上的舌、口底癌。对于无明显口底受累的T1~2N0期舌癌可采用非连续性颈淋巴清扫术,以减少手术对口腔功能的影响。

Squamous cell carcinoma of tongue and floor of the mouth(SCCOTFM)accounts for approximately fifty percent of oral cancer.This region is complicated in anatomy,abundant in lymphatic circulation and prone to metastasis.Neck dissection is the most effective modality to control cervical recurrence and metastasis.Sentinel lymph node biopsy and lymphatic mapping are helpful for preoperative evaluation of the indications of neck dissection.Lingual lymph nodes are closely related to the recurrence and metastasis of SCCOTFM.In-continuity neck dissection can remove the lymphatic channel and lymph nodes of tongue and between floor of the mouth and neck,which makes the clearness of pathological tissues more thorough and is suitable for SCCOTFM larger than T2 stage.Discontinuous neck dissection should be used for T1-2N0 stage carcinoma of the oral tongue without involvement of floor of the mouth,to avoid oral dysfunction by surgery.