口腔部鳞癌颈淋巴结转移特点与应取术式关系的探讨  

An inquiry into the relation of the neck metastasis of the oral squamous cell carcinoma and the apprapriate patterns of neck dissection

作　　者：刘云生 魏奉才 宋代辉 

出　　处：《中国耳鼻咽喉头颈外科》1998年第S1期37-,378+39,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：回顾性调查了８４例口腔鳞癌患者颈郭清术后标本中颈淋巴结转移的分布特点，发现临床检查的假阳性率为５１．７％，假阴性率为７０．８％。在４６例病理证实已发生颈淋巴转移的患者中，ｌｅｖｅｌＩ的转移率为８４．８％，其中５３．８％伴其他平面转移，约１５．４％跳越转移至ｌｅｖｅｌⅣ和Ⅴ。当淋巴ｌｅｖｅｌⅠ、Ⅱ、Ⅲ无阳性发现时，Ⅳ，Ⅴ发生转移者分别为４．４％和２．２％，当ｌｅｖｅｌⅠ，Ⅱ，Ⅲ特别是Ⅲ有转移时，Ⅳ，Ⅴ伴发转移者为４４．４％。结论：肩胛舌骨上颈淋巴清扫术适用于大多数无或仅有ｌｅｖｅｌⅠ，Ⅱ转移的病例。当ｌｅｖｅｌⅢ有阳性淋巴结时，应取其他术式。临床检查并非是准确判断转移程度的手段，要想确定淋巴平面的实际转移水平，术中冰冻切片活检才是可靠方法。Abstract The scattered pattens of lymphatic involvement of 84 patients with squamous cell carcinoma of the oral cavity were eveluated ,including 46 positive neck metastasis confirmed by pathologic specimens. The proportion of false- positive and false-negtive were found to be 51.7% and 70.8%, associated with clinical examination. The involv- ment of level Ⅰ was 84.8%, 53.8% of them shared the involvment of other levels. The involvment of level Ⅳ and Ⅴwas 15. 4% in the later. When the levels Ⅰ、Ⅱ、Ⅲ were not involved , the positive rate of neck involvement were 4.4% and 2.2%,at levels Ⅳand Ⅴ. ln the presence of pathologically involved nodes at level Ⅲ,the prevalence of metastais disease at levels Ⅳ and Ⅴ was 44.4 %. Conclusion. Supraomohyoid neck dissection is appropriate for most of the cases whose metastasis disease were confined only at levels Ⅰ and Ⅱ. lf level Ⅲ was involved , other patterns of neck disection should be used. Clinical examination was not a reliable method to confirm the extent on neck metastasis. The only reliable means to fufil the purpose is the frozen section biopsy.

关 键 词：口腔肿瘤(Mouthneoplasms) 癌(Carcinoma) 淋巴转移(Lymphaticmetastasis) 

分 类 号：R739.85[医药卫生—肿瘤]