合理的根治性颈淋巴清扫术的临床应用评价  

Clinical assessment of rational radical neck dissection

作　　者：杨凯[1] 张福军[1] 李雅冬[1] 张劲松[1] 陈睿[1] 

机构地区：[1]重庆医科大学附属第一医院口腔颌面外科,400016

出　　处：《实用口腔医学杂志》2007年第4期499-502,共4页Journal of Practical Stomatology

摘　　要：目的：评价保留颈外静脉、耳大神经和颈神经丛深支的新型改良根治性颈淋巴清扫术（或称合理的根治性颈淋巴清扫术）在治疗口腔癌颈淋巴转移灶中的临床应用价值。方法：TNM分期在T2N1M0—T4N3M0之间的口腔鳞癌初诊患者45例，随机分为2组（RND组和RRND组），RND组行传统根治性颈淋巴清扫术（22例），RRND组行合理的根治性颈淋巴清扫术（23例），比较2种手术方式的颈淋巴结术后复发率和并发症。结果：RRND组术后患者面部水肿及头晕、头痛症状显著低于RND组（P〈0．05）；术后6个月复查，RRND组患者耳廓和肩部麻木感显著低于RND组，耳廓皮肤感觉功能和肩运动功能显著高于RND组（P〈0．05）；随访3年，RRND组和RND组术后颈淋巴结复发率分别为8．70％、4．55％，差别无统计学意义（P〉0．05）。结论：合理的根治性颈淋巴清扫术与传统根治性颈淋巴清扫术相比，不会增加术后颈淋巴结复发率，但极大地提高了患者术后的生存质量。Objective：To evaluate clinical application of a modified radical neck dissection with the preservation of external jugular vein, auricular magnum nerve and deep branches of cervical nervous plexus （ also known as rational radical neck dissection, RRND） for the patients with oral squamous cell carcinoma （OSCC）. Methods：45 patients with T2N1M0 -T4N3M0 OSCC were divided randomly into two groups, 22 cases were treated by radical neck dissection （group RND） and 23 cases were treated by rational radical neck dissection （group RRND）. The recurrence rates of cervical lymph node and postoperative morbidity between two groups were compared. Results： Postoperation facial edema and headache in＇group RRND were weaker than that in group RND（ P 〈0.05 ）. Six months after operation, shoulder and ear numbness in group RRND were significantly weaker than that in group RND, ear skin sensation and shoulder movement function in group RRND were better than that in group RND（ P 〈0.05 ）. Following up 3 years, the cervical recurrent rates of group RRND and group RND were 8.70% % and 4.55% respectively （ P 〉 O. 05 ）. Conclusion：Compared to RND, RRND for T2NIM0 - T4N3M00SCC does not increase the recurrent rates of cervical lymph node, while it can improve the quality of life for patients with oral cancer.

关 键 词：颈淋巴清扫术 口腔癌 颈外静脉 耳大神经 颈神经丛深支 生存质量 

分 类 号：R739.8[医药卫生—肿瘤]