舌及口底鳞癌治疗分析

Clinic analysis of tongue-mouth floor squamous cell carcinoma

目的 探讨舌及口底鳞癌淋巴转移的手术时机与方式对预后的影响。方法 舌及口底鳞癌67例,非手术组12例(为cN_(2～3)患者),手术组55例。cN_028例行原发灶切除,其中23例行选择性颈淋巴清扫。27例cN_(1～3)(cN15例、cN_(2～3)22例)行原发灶切除加根治性颈淋巴清扫,其中16例cN_(2～3)行岛状肌皮瓣修复术:结果 在34例患者中(cN_(2～3)),手术组5年生存率为54.55％(12/22),非手术组5年生存率为41.67％(5/12)。28例cN_0患者中,4例单纯癌肿切除者术后45～60天出现淋巴转移;23例行选择性颈淋巴结清扫术者,证实13例有隐匿性淋巴结转移,10例未见淋巴结转移。结论 对cN_0患者应尽早行选择性颈淋巴结清扫术。对多区域淋巴结或一个区域多个淋巴结转移的cN_(2～3)患者,手术比非手术组的生存率更高,但后者对提高5年生存质量有一定作用。

Objective To study the prognosis variation a- mong different operative styles and its times in lymph-node metastasis of tongue-mouth floor squamous cell carcinoma. Methods Sixty-seven cases of tongue-mouth floor carcinoma divided into two groups: non-operative group with 12 cases in cN0, operative group with 55 cases in cN0. Of 28 cases with primary region resected in cN0, twenty-three were treated with selecting neck lymphnode dissection. Of 27 cases in CN1-3 being treated with radical neck lymphnode dissection, sixteen were reconstructed with my-ocutaneous island flaps. Results Of 34 cases (cN2-3), 5 years survival rate was 54.55 % (12/22) in operative group and 41.67 % (5/12) in on-operative group. Of 28 cases (cN0),four presented neck lymphnode metastasis in 45 to 60 days when primary carcinoma were dissected. Among 23 cases with selective neck dissection, occult lymphnod metastasis were found by pathology examination. Conclusion Selecting neck lymphnode dissectinn in cN0 can promote 5 years survival-rate. Operative group can present higher 5 years survival-rate than no-operative group treatment, and the later has a better living quality in cN2-3