舌体鳞癌隐匿性颈淋巴结转移的外科治疗探讨  

Surgical Management for Occult Cervical Metastasis of Oral Tongue Squamous Cell Carcinoma

作　　者：郭朱明[1] 王顺兰[1] 曾宗渊[1] 陈福进[1] 张诠[1] 魏茂文[1] 杨安奎[1] 伍国号[1] 彭汉伟[1] 

机构地区：[1]中山大学肿瘤防治中心头颈科,广东广州510060

出　　处：《癌症》2005年第3期368-370,共3页Chinese Journal of Cancer

基　　金：广东省医学科研基金(No.A2002226);广东省科技计划项目(No.2002-254-3)~~

摘　　要：背景与目的:对于临床颈淋巴结阴性(cN0)的舌癌颈部的处理一直存在争议,本研究旨在探讨cN0舌体鳞癌颈部的合理治疗方案。方法:回顾性分析187例手术前后未行放、化疗的cN0舌体鳞癌初诊患者的临床资料;分析颈部隐匿性淋巴结转移规律和隐匿性淋巴结转移及预后的影响因素,以及颈部不同处理方式的控制情况。结果:隐匿性淋巴结转移率为23.0%,其最常见的位置在同侧颈Ⅱ区,83.0%的隐匿性淋巴结转移分布在同侧颈Ⅰ、Ⅱ、Ⅲ区;病理分级是影响隐匿性淋巴结转移的独立因素;隐匿性淋巴结转移为影响cN0舌癌患者预后的独立因素;肩胛舌骨肌上清扫术的颈部复发率为6.7%。结论:肩胛舌骨肌上颈清扫术是cN0舌体鳞癌患者有效而安全的治疗措施。BACKGROUND & OBJECTIVE: In oral tongue squamous cell carcinoma (SCC), the management for clinically negative (cN0) neck remains controversial. This study was to explore rational neck management for cN0 cases. METHODS: Clinical data of 187 patients with oral tongue SCC of cN0, who received surgery alone, were retrospectively reviewed. Rules of occult nodal metastasis, factors that impact cervical node metastasis, and prognostic factors were analyzed. Neck recurrences of different treatment groups were compared. RESULT: Incidence of occult nodal metastasis in all patients was 23.0% (43/187). The most common site of occult nodal metastases was ipsilateral level Ⅱ. About 83.0% of occult nodal metastases were found in ipsilateral levels Ⅰ, Ⅱ, and Ⅲ. Pathologic grade was an independent influencing factor for occult neck metastases. Occult neck metastasis was an independent prognostic factor for oral tongue SCC. Supraomohyoid neck dissection (SOHND) was an effective therapeutic method for oral tongue SCC of cN0; the neck recurrence rate after SOHND was only 6.7%. CONCLUSIONS: SOHND is the effective and safe treatment for oral tongue SCC.

关 键 词：舌肿瘤 鳞状细胞癌 淋巴结转移 颈清扫术 

分 类 号：R739.86[医药卫生—肿瘤]