口腔黏膜恶性黑色素瘤颈淋巴结转移区域特点初探  

Study on Regional Characteristic of Lymphatic Metastasis of Oral Mucosal Melanoma

作　　者：杨溪[1] 任国欣[1] 郭伟[1] 张陈平[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面外科上海市口腔医学重点实验室,上海200011

出　　处：《口腔颌面外科杂志》2010年第4期257-261,共5页Journal of Oral and Maxillofacial Surgery

基　　金：上海市重点学科(优势学科)建设项目(0203);上海市科委科技发展基金(08140902100);上海市科委项目(10410711200)

摘　　要：目的:通过分析口腔黏膜原发性黑色素瘤颈淋巴清扫术后标本中淋巴结转移情况,探索口腔黏膜恶性黑色素瘤的颈淋巴结转移特点,为颈清术式的选择及标本的规范处理提供指导。方法:收集整理1999-08—2009-07我院口腔病理科的原发性口腔黏膜恶性黑色素瘤的病例资料,用HE和免疫组化染色重新判定颈淋巴结转移的情况。结果:在获得的56个病例中,发生转移的共50例,86%的颈淋巴结转移多发于Ⅰ～Ⅲ区(43/50例),在Ⅰ～Ⅲ区的标本中淋巴结转移阳性率为21.1%(215/1017枚),Ⅳ区和Ⅴ区为4.57%(18/394枚);19例术前临床诊断无转移者(cN0)中有13例术后病理发现存在颈淋巴结转移,假阴性率达68.5%。结论:口腔黏膜恶性黑色素瘤的cN0患者应接受选择性颈淋巴结清扫,术式宜选择功能性肩胛舌骨上清扫术;应重视颈清术后标本淋巴结的分区送检,尤其Ⅴ区的送检。Objective： To review the characteristics of lymphatic metastasis of oral mucosal melanoma and to explore the regional features of metastasis. Methods： Data of 56 patients from August 1999 to July 2009 were retrospectively reviewed. Results： 50 patients had the cervical lymphatic metastasis. The lymphatic metastasis of oral mucosal melanoma mostly concentrated in areas I to m （43 / 50）. The percent of the metastasis positive lymph nodes of the inspected ones in area I to IlI was 21.1% （215/1017）,while the positive percentage in area IV to V was 4.57% （18/394）. Clinical diagnosis of 19 cases showed no lymphnode metastasis preoperation, but 15 of them were subsequently confirmed with positive metastasis by pathology. The false negative percentage was 78.9%. Conclusion： Elective neck dissection should be advocated to CNO patients of oral mucosal melanomas. The functional supraomohyoid neek disseetiou was preferable. The inspection of cervical lymph nodes should be emphasized, espeeially in area V.

关 键 词：口腔黏膜 恶性黑色素瘤 颈淋巴清扫术 淋巴结 

分 类 号：R739.8[医药卫生—肿瘤]