cN0口腔鳞癌患者Ⅱb区淋巴结转移102例研究

Analysis of metastases to levelⅡb lymph nodes in 102 patients with cN0 oral squamous cell carcinoma

目的:统计cN0口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)患者Ⅱb区淋巴结转移情况,从而探讨择区性颈淋巴结清扫(selective neck dissection,SND)时处理Ⅱb区域的必要性。方法:收集我院口腔颌面外科2014年1月-2015年7月行颈淋巴结清扫术及原发灶手术治疗的cN0 OSCC患者的资料,共102例(102侧),并统计患者Ⅰ~Ⅳ区淋巴结转移情况,记录所有患者术前,术后1~2个月、3~5个月、1年、2年和5年的肩功能、生存质量[美国华盛顿大学生存质量问卷(the University of Washington quality of life questionnaire,UW-QOL questionnaire)]情况及转移情况。结果:90例行肩胛舌骨肌上颈淋巴结清扫术(supraomohyoid neck dissection,SOND),12例行Ⅰ~Ⅳ区择区性颈淋巴结清扫术。102例OSCC患者中,淋巴结转移以Ⅰb、Ⅱa、Ⅲ区多见,Ⅱb和Ⅳ区少见。单独发生在Ⅱb区的转移淋巴结仅有1例患者。术后2周内,大多数患者存在轻度至中度的肩部不适,但无1例主述存在麻木感。术后1~5年,大多数患者的肩功能和生存质量均明显恢复(P<0.05),与术前水平相当(P>0.05)。结论:cN0 OSCC患者Ⅱb区的淋巴结转移率很低,在清扫过程中未探及明显肿大淋巴结,尤其是当Ⅱa区无明显肿大淋巴结时,进行肩胛舌骨肌上淋巴结清扫术及Ⅰ~Ⅳ区的择区性颈淋巴结清扫术时可酌情考虑不处理Ⅱb区,以减少术后出现肩部功能障碍的可能性,提高患者术后生活质量。

Objective:To investigate the metastases to levelⅡb regional lymph nodes in patients with cN0 oral squamous cell carcinoma(OSCC),and to access the necessity of treating levelⅡb nodes during selective cervical lymph node dissection.Methods:The data of 102 cases(102 sides)of cN0 OSCC patients who underwent cervical lymphadenectomy and primary surgery in our hospital from January 2014 to July 2015 were collected.Metastases data ofⅠ-Ⅳlymph nodes was calculated.The shoulder function and quality of life[the University of Washington quality of life questionnaire(UW-QOL questionnaire)]of the patients before operation,1-2 months,3-5 months,1 year,2 years,5 years after operation,survival and transfer condition within 5 years after operation were also recorded.Results:90 patients underwent supraomohyoid neck dissection(SOND)and 12 patients underwentⅠ-ⅣSND.Among 102 OSCC patients,lymph node metastases were more common inⅠb,Ⅱa andⅢ.Lymph node metastases were rare inⅡb andⅣ.Only 1 patient had metastasis inⅡb.Within 2 weeks after surgery,most patients had mild to moderate shoulder discomfort,but no one reported numbness.From 1 to 5 years after surgery,the shoulder function and quality of life of most patients were significantly restored(P<0.05),which was comparable to the preoperative level(P>0.05).Conclusion:The metastasis rate ofⅡb in cN0 OSCC patients is very low.When there is no obvious enlarged lymph nodes,especially when there is no obvious enlarged lymph nodes in theⅡa area,it can be considered not to deal withⅡb during SOND and SND inⅠ-Ⅳ,so as to reduce the possibility of postoperative shoulder dysfunction on the affected side and improve the patient′s quality of life after surgery.