口腔鳞癌患者颈部处理原则探讨

Neck management of oral squamous cell carcinoma for cNo patients

目的探讨口腔鳞癌患者颈部处理原则。方法通过对1977年-2002年武汉大学口腔医学院口腔颌面外科行根治性颈淋巴结清扫术的668例口腔鳞癌患者进行回顾性研究,重点分析肿瘤大小、颈淋巴结状况与转移的关系,并对其颈部处理原则进行探讨。结果各部位口腔鳞癌的颈淋巴结平均转移率为40%(267/668),而在术前临床检查中未发现颈部肿大淋巴结的患者(cNo患者)在术后经病理证实有颈部淋巴结转移者(隐匿性转移)占21.6%(54/249)。结论对原发灶直径小于2cm、仅限于黏膜层的表浅肿瘤,且临床上未检测到肿大淋巴结的患者应将原发灶包括部分周围的正常组织彻底切除;对肿瘤直径虽小于2cm,但已侵入黏膜下层或生长迅速、低分化的癌瘤,可考虑行选择性颈部淋巴结清扫术;当肿瘤直径大于2cm,无论临床上是否检测到肿大淋巴结,因其隐匿性转移率高,应行颈淋巴结清扫术。

Objective To study the principle of neck dissection for patients of oral squamous cell carcinoma(SCC). Methods 688 cases of SCC were retrospectively analyzed,especially the location of primary lesion,the degree of cell differentiation,the condition of neck lymph nodes and the size of the tumors. Results The total rate of cervical lymph node metastasis with SCC was 40% (267/668). But,in the group of patients with clinically negative cervical lymph nodes(cNo ),the rate of occult lymph node metastasis (ONM) was 21.6% (54/249). According to this study,the incidence of metastasis was closely related to the size and the condition of the lymph nodes. Conclusion The results of this study suggest that carefull clinical examination and comprehensive analysis may be helpful to determination of the lymph node metastasis and the treatment.