下颌牙龈癌颈部淋巴结转移特点及颈淋巴结清扫术式探讨  

Patterns of cervical lymph node metastasis in gingival squamous cell carcinoma and selection of neck dissection

作　　者：段青云[1] 贾暮云[2] 张雄[1] 张存宝[1] 蒋峰[1] 冯红杰[1] 朱旌[1] 

机构地区：[1]杭州市第一人民医院口腔科,310006 [2]青岛大学医学院附属医院口腔颌面外科

出　　处：《浙江医学》2013年第24期2170-2172,2175,共4页Zhejiang Medical Journal

摘　　要：目的探讨下颌牙龈癌颈淋巴结转移的分布特点,为选择合理的颈淋巴结清扫术式提供参考。方法选取下颌牙龈癌患者42例,依据国际抗癌联盟2002年标准分期,分析不同分期患者颈部淋巴结转移情况,依据美国耳鼻咽喉头颈外科学会1991年公布的颈部淋巴结Level分区法,计数常规病理检查不同分区的阳性淋巴结数,比较不同临床分期患者颈部不同区域淋巴结转移的分布差异。结果T_1期9例,T_2期16例,T_3期6例,T_4期1 1例;15例患者共47枚淋巴结出现转移,主要发生在LevelⅠ、Ⅱ和Ⅲ区。Ⅰ区淋巴结转移率13.33%(22/165),Ⅱ区淋巴结转移率12.40%(16/129),Ⅲ区淋巴结转移率7.03%(9/128),Ⅳ区和Ⅴ区无淋巴结转移;Ⅰ、Ⅱ和Ⅲ区淋巴结转移率的差异均无统计学意义(均P>0.05)。不同分期患者转移率的差异无统计学意义(均P>0.05),但T_3、T_4期患者转移率明显高于T_1、T_2期患者;除T_1期与T_2期、T_1期与T_3期患者颈部淋巴结转移率的差异无统计学意义外,其余各期患者两两比较的差异均有统计学意义(P<0.05或0.01)。结论下颌牙龈癌颈部转移主要发生在Ⅰ、Ⅱ和Ⅲ区,若无明确的Ⅳ、Ⅴ区转移证据,无需同期行Ⅳ、Ⅴ区淋巴结清扫。Objective To examine the distribution of cervical lymph node metastasis of mandibular gingival squamous cell carcinoma and to select neck dissection mode. Methods Forty two patients with mandibular gingival squamous cell carci- noma were enrolled. The stages were classified according to the International Union Against Cancer （2002）. The ＂Level＂ partition method of American Society of Otorhinolaryngology Head and Neck Surgery （1991） was used to analyze the number of positive lymph nodes in different partitions by routine pathological examination, and the distribution of cervical lymph node metastasis was compared among patients of different clinical stage. Results There were 9 T1 cases, 16 T2, 6 T3 and 11 T4 in total 42 patients. Fifteen patients had metastasis in cervical lymph node （total 47 nodes）; the metastasis rate was 13.33%（22/165） in Level I , 12.40%（16/129） in level Ⅱ and 7.03%（9/128） in level Ⅲ ; no lymph nodes metastasis were found in level IV and V. There was no difference in cervical lymph node metastasis among the level I, Ⅱ and Ⅲ （X2=0.06, 2.85,1.94, P 〉0.05）. The metastasis rate of cervical lymph nodes in patients of T3 and T4 was higher than those in T1 and T2 stages; there were significant differences in metastasis rates among patients with different stages, except T1to T2 and T1 to T3 （P〈0.05 or 0.01）. Conclusion The metastases of mandibular gingival squamous cell carcinoma to neck mainly were in level I, Ⅱ and Ⅲ . if there is no clear evidence it is not necessary to dissect cervical lymph node in level IV and V.

关 键 词：牙龈鳞状细胞癌 颈淋巴结 颈清扫术 

分 类 号：R739.8[医药卫生—肿瘤]