口腔鳞癌患者下颌骨受侵的术前诊断和处理

目的：探讨临床检查、影像学检查（X线、CT、MRI）及术中探查诊断口腔鳞状细胞癌侵犯下颌骨及选择手术方式的价值。方法：对1993～2004年间49例口腔鳞状细胞癌行手术治疗的患者资料进行总结，将临床检查、影像学检查（X线、CT、MRI）及术中探查判断下颌骨受侵的结果与术后病理进行比较。利用SPSS13．0统计软件包比较上述方法在诊断下颌骨受侵及选择下颌骨手术方式上的价值。结果：临床检查诊断下颌骨受侵的敏感度为42．9％（9／211．特异度为100％（28／28），阳性预测值为100％（9／9），阴性预测值为70.0％（28，40），准确率为75.5％（37/49）；术中探查分别为：90．5％（19/21）、75．0％（21/28）、73．1％（19/26）、91.3％（21／23）和81．6％（40/49）；X线、CT、MRI的敏感度分别为100％（2/2）、83．3％（10／12）和40％（2/5）；特异度分别为100％（5／5）、100％（11／11）和100％（2／2）。下颌骨未受侵而行下颌骨切除者28例，其中帽状切除20例，骨段切除8例；而下颌骨受侵的21例患者中，行帽状切除3例，骨段切除18例。下颌骨手术方法对患者生存率的影响无显著性差异（P＞0．05）。结论：综合应用临床检查、下颌骨X线片、CT、MRI及术中探查能提高口腔癌下颌骨受侵诊断的准确率，为保留下颌骨的完整性提供比较可靠的依据。

The diagnostic accuracy of different methods in assessment of mandible involvement in oral squamous cellcarcinoma and subsequent management

PURPOSE: To assess the predictive values of clinical examination, X-ray, CT, MRI and intraoperative examination in detecting mandible involvement of oral squamous cell carcinoma(SCC). METHODS: 49 patients with oral SCC treated with primary resection in Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences between 1993 and 2004 were reviewed retrospectively. All patients were pathologically confirmed to be squamous cell carcinoma. The results of clinical examination, X-ray, CT, MRI and intraoperative examination were compared with the pathological results with SPSS13.0 software package to analyze the predictive capabilities of these methods in detecting mandible involvement and the value in guiding operations. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of mandible invasion were 42.9% (9/21),100%(28 / 28),100% (9/9),70.0%(28/40) and 75.5%(37/49) by clinical examination; 90.5% (19/21),75.0%(21/28),73.1%(19/26),91.3% (21/23), 81.6%(41/49) by intraoperative examination; The sensitivity of X-ray, CT, MRI were 100%(2/2), 83.3%(10/12), 40%(2/5), respectively;the specificity were 100%(5/5), 100%(11/11), 100%(2/2), respectively. Twenty-eight uninvolved mandibles were resected, including 20 marginal and 8 segmental mandibulectomy. For 21 mandibles with invasion, 3 marginal and 18 segmental mandibulectomy were performed. No significant difference in survival rate was found between different operative methods. CONCLUSIONS: Pre-operative assessment with combined clinical examinations and radiographic evaluations are adequate for mandible invasion in oral SCC and valid for mandibular conservation surgery.