评估口腔颌面癌瘤的双侧颈淋巴清扫术

本文报告双侧颈清扫术48例,其三年,五年、十年生存率分别为45.94％、37.93％、25％。术后明确颈淋巴转移者39例,占81.25％。侵蚀的淋巴结共计178枚,颈深上区占44％、颌下区占29％、颈深中区占10％、颏下区占8％、颈深下区占5％、颈后区占2％,依据预后和颈淋巴结转移来分析双侧颈清扫术与肿瘤类型、原发部位、手术时期和术式的临床意义。并讨论了手术指征、术式选择、和对同期组与分期组作了评估。     

选择性颈淋巴清扫术及其适应证的评价

作者通过对３８２例行颈淋巴清扫术的口腔癌患者的回顾性研究，对选择性（即预防性）颈清扫术及其适应证进行评估。本研究重点分析了各种相关因素与颈淋巴结转移的关系。结果表明：各种口腔癌的颈淋巴结总转移率为４４％（１６７／３８２）。而在术前未扪及肿大淋巴结者即隐匿性转移率为２３％（１９／８４）。颈淋巴转移的发生频率与原发灶的大小、部位、肿瘤细胞的分化程度和肿瘤类型等密切相关。特别是颈淋巴结的状况是评估颈部转移的重要信息。本研究强调对原发灶及颈淋巴的仔细检查和综合分析，有助于更准确判断是否有颈淋巴转移及是否应行ＥＮＤ。     

保留颈深神经和颈外静脉的改良颈淋巴清扫术的临床研究

根治口腔鳞癌时采用传统的颈淋巴清扫术常行整块颈部组织切除,由此会带来一些不可避免的术后并发症,对患者肩功能造成严重的影响。笔者采用保留颈外静脉及颈神经丛深支的颈淋巴清扫术,大大降低了患者术后并发症的发生率,提高了患者的生存质量,现将结果报道如下。1对象和方法1.1     

选择性颈淋巴清扫术及其适应证的评价

作者通过对３８２例行颈淋巴清扫术口腔癌患者的回顾性研究，对选择性（即预防性）颈清扫术及其适应证进行评估，本研究重点分析了各种相关因素与颈淋巴结转移的关系。结果表明，各种口腔癌的颈淋巴结总转移率为４４％（１６７／３８２）。而在术前未Ｍｅｎ 大淋巴结者即隐匿性转移率为２３％（１９／８４），颈淋巴转移的发生率与原发灶的大小，部位，肿瘤细胞的分化程度和肿瘤类型等密切相关，特别是淋巴结的状况是评估颈部分的重     

舌鳞癌颈淋巴转移的临床研究

目的：为了探讨舌鳞癌颈巴结转移的规律及临床治疗的关系。方法：对96例舌鳞癌根治性颈清扫标本的转移性淋巴结在颈部的分布进行了回顾性分析。结果：颈部淋巴结转移病理阳性的总发生率52．1％。N0,N1,N2,N3的Ⅳ区、Ⅴ区淋巴结转移率分别为：3．3％,5．0％,30．0％,31．3％。病理证实仅有I区或Ⅱ区淋巴结转移,而无Ⅲ区淋巴结转移时,Ⅳ区、Ⅴ区淋巴结转移率为4．2％,有Ⅲ区淋巴结转移时,Ⅳ区、Ⅴ区淋巴结转移率为57．7％。结论：对于N0和N1的舌鳞癌患者可行肩胛舌骨上清扫,N2和N3的舌鳞癌者应行根治性清扫。行肩胛舌骨上清扫时,行Ⅲ区淋巴结冰冻切片检查,根据结果决定是否同时清扫Ⅳ区、Ⅴ区。     

肩胛舌骨上颈淋巴清扫术对控制口腔癌NO淋巴结转移的作用

目的:对施行根治性(RND)和肩胛舌骨上颈淋巴清扫术(SOHND)的NO期口腔癌患者进行回顾性比较研究,探讨肩胛舌骨上颈淋巴清扫术对控制口腔癌。NO淋巴结转移的作用。方法:对182例NO期口腔癌患者进行随访,并根据手术方式分为RND组和SOHND组,对颈淋巴转移、肿瘤复发及5年生存率进行统计分析。结果:本组资料颈淋巴结隐匿性转移率为27.5％,颈淋巴转移率随T分期升高而升高;口腔癌最易向颈深上淋巴结转移,其次是下颌下淋巴结和颈深中淋巴结,Ⅰ至Ⅲ平面转移占总转移率的92.0％;术后肿瘤复发率为17.0％,以局部和同侧颈部复发为主;RND对控制NO期口腔癌颈淋巴转移的有效率为95.2％,SOHND的有效率为94.8％;RND组5年生存率为67.6％,SOHND组为72.7％;两组间复发率及5年生存率无显著性差异。结论:肩胛舌骨上颈淋巴清扫术不仅能够评价NO期口腔癌颈淋巴结转移状况,而且能够有效控制发生隐匿转移的颈淋巴结。对于NO期口腔癌,选择性颈淋巴清扫术可采用肩胛舌骨上颈淋巴清扫术作为标准的治疗程序。     

唇癌的淋巴转移与预防性颈淋巴结清扫术的意义

本组共31例,男性21例、女性10例。年龄22～84岁,其中83.9%(26/31)在50岁以上。绝大部份(83.9%)发生于下唇,4例发生于上唇,1例发生于口角。80.6%(23/31)的患者病程在2年以内。就诊时原发灶多已大于2cm。31例中鳞状细胞癌21/31占67.7%,其中5例为Ⅱ级鳞癌、16例为Ⅰ级鳞癌。其余基底细胞癌2例;囊性腺样癌、疣状癌、乳突瘤恶变各1例。     

山东大学口腔医学院举办颈淋巴清扫术百年讲座

2008年11月26日，山东省齐鲁医院口腔颌面外科专家刘云生副教授在山东大学口腔医学院口腔西楼5层多媒体教室作了有关“颈淋巴清扫技术100周年”的讲座。山东大学口腔医学院的研究生及部分本科学生参与了此次讲座。     

两种颈淋巴清扫术后颈淋巴结复发率分析

口腔颌面部恶性肿瘤发生颈部转移较为常见,手术中常需联合颈淋巴清扫术以阻断此传播途径,减少复发。颈部转移性鳞癌的根治性颈清术(radical neck dissection,RND)作为经典术式广泛应用于临床,取得了肯定的疗效。随着对颈部解剖认识的深入,Suarez于1963年提出了功能性颈清术(func-tional neck dissection,FND)的概念,经过多年的临床应用证明了     

Prognostic value of lymph node count from selective neck dissection in oral squamous cell carcinoma

Unlike the levels of anatomical exploration, there is no consensus on the extent of lymph node dissection, or lymph node count (LNC), during selective neck dissection (SND). The aim of this study was to validate the prognostic impact of LNC on survival and to determine an optimal LNC cut-off value for SND. A retrospective investigation identified 78 patients with a diagnosis of oral squamous cell carcinoma (OSCC) who underwent SND (levels I–III or levels I–IV). LNC and clinicopathological variables were analyzed for any association with survival in Cox proportional hazards models. Based on the receiver operating characteristic curve, a cut-off value of 19 lymph nodes was found to predict overall survival (OS) (area under the curve 0.732, sensitivity 67.8%, specificity 75.0%; P = 0.026) and disease-specific survival (DSS) (area under the curve 0.762, sensitivity 68.1%, specificity 77.8%; P = 0.011). On Cox regression, LNC (≥19 vs. <19) was the only independent predictor of OS (hazard ratio 5.29, 95% confidence interval 1.39–20.05; P = 0.014) and DSS (hazard ratio 6.76, 95% confidence interval 1.40–32.77; P = 0.018). Similar results were obtained in the pathologically lymph node-negative subgroup (n = 66). Based on the study findings, SND should include 19 or more lymph nodes for a survival benefit.     

Sentinel lymph node biopsies in early stage oral and oropharyngeal carcinoma: a retrospective single-centre experience

The aim of this retrospective study was to analyse a consecutive series of patients with oral and oropharyngeal carcinoma who had had sentinel lymph node biopsy (SLNB) at our hospital during 2008-2017. A total of 70 patients with clinically and radiologically confirmed primary oral (n = 67) or oropharyngeal (n = 3) carcinoma, with no signs of metastatic lymph nodes preoperatively (clinically N0) were included. Patients’ clinical and personal data, characteristics of the tumours, sentinel lymph node (SLN) status and outcomes were recorded. Eight patients had invaded SLN. Two patients with clear sentinel lymph node biopsies had recurrences in the cervical lymph nodes with no new primary tumour as origin. The negative predictive value (NPV) and sensitivity for SLNB were 97% and 80%, respectively. The depth of invasion was an individual predictor for cervical lymph node metastasis (p = 0.043). Single photo emission computed tomography (SPECT) detected fewer SLN in patients with invaded lymph nodes than in patients with clear lymph nodes (p = 0.018).Our data support the use of SLNB as a minimally invasive method for staging the cervical lymph nodes among patients with cN0 oral and oropharyngeal carcinoma. Our results further confirm that greater depth of invasion is associated with cervical lymph node metastases.     

口腔癌对侧颈淋巴结转移的高危因素分析

目的：分析影响口腔癌患者发生对侧颈淋巴结转移的临床病理因素.方法：收集2010年6月～2011年6月间217例中发生对侧颈淋巴结转移的口腔癌病历资料13例,对其临床病理特点进行分析.结果：口腔癌对侧颈淋巴结转移多发于年轻患者,部位以舌、口底常见,并与临床分期、病理分级、同侧颈淋巴转移等因素密切相关,其协同作用可能加快其转移.结论：在≤45岁、肿瘤范围越过中线、侵及口底、≥T3期、低分化鳞癌、同侧颈淋巴结转移等因素中若出现两项或以上者,则有必要考虑同期行对侧颈淋巴结清扫术,以提高患者治愈率和生存率.     

111例cN0口腔鳞状细胞癌患者颈部淋巴结转移临床分析

目的 探讨颈部淋巴结阴性（clinically negative cervical lymph node,cN0）的口腔鳞癌（oral squamous cell carcinoma, OSCC）患者发生颈淋巴结隐匿性转移的规律和相关影响因素。方法 收集承德医学院附属医院2007年5月—2017年5月接受颈淋巴结清扫术的111例cN0口腔鳞癌患者的临床和病理资料,进行回顾性分析。采用SPSS 17.0软件包中χ²检验,分析隐匿性转移与年龄、性别、原发灶部位及病理分级的关系。结果 111例cN0口腔鳞癌患者中,总隐匿性转移率为27.03%（30/111）。cN0口腔鳞癌患者淋巴结转移率与性别、年龄及发病部位无显著相关（P>0.05）,与病理分期存在显著相关（P<0.05）。结论 肿瘤分化程度越低,颈淋巴结隐匿性转移率越高。临床上对此类患者,应积极行颈淋巴清扫术。     

舌体鳞状细胞癌cN0患者的颈淋巴结转移临床分析

目的 分析临床颈部阴性(cN0)的舌体鳞状细胞癌隐匿性颈淋巴结转移率和与转移相关的临床因素，探讨cN0患者的颈部治疗原则。方法 回顾性分析94例cN0舌癌患者的临床和病理资料，探讨隐匿性转移的发生率和转移规律。结果 94例cN0舌癌中，病理检查证实颈淋巴结转移者39例，其中T1～T4期肿瘤的转移率依次为28．6％，35、0％，56．5％和60．0％。高分化和中低分化舌癌的转移率分别为23．1％和54、6％。原发灶生长方式为外突型、溃疡型和浸润型病变的转移率依次为13．3％，27、3％和60、8％。单个淋巴结转移者19例，多个淋巴结转移(累及一个或多个颈部分区)者20例。共有55个颈部分区检出阳性淋巴结，各区转移频率依次为：Ⅰ区，32．7％(18／55)；Ⅱ区，41.8％(23／55)；Ⅲ区，23．6％(13／55)；Ⅳ区，1、8％(1／55)，未见累及Ⅴ区者。结论 ①原发灶的病理分级和生长方式可以作为术前判断颈淋巴结转移的参考因素。②高分化的T1期病变可行颈部观察，但对于分化程度较低、生长方式呈浸润型或溃疡型者宜行选择性颈淋巴清扫术。T2～T4期病变须行同期选择性颈淋巴清扫术。③建议对cN0舌癌行扩大性肩胛舌骨上颈淋巴清扫(清扫Ⅰ～Ⅳ区)，避免全颈淋巴清扫术给患者造成的损害。     

双能量CT在颈部淋巴结病变评估中的研究进展

头颈部淋巴结病变的早期发现及定性诊断至关重要,有助于临床及时采取干预措施及制定治疗方案,延缓或终止疾病进展。目前双能量CT的多组图像,如虚拟平扫图像、碘图、虚拟单能量图像、光谱亨斯菲尔德单位衰减曲线及混合图像等已逐步用于评估头颈部淋巴结病变,为淋巴结病变的定性、分期及病理分型提供了诸多量化指标。本文就双能量CT的多组后处理图像及相关参数在颈部淋巴结病变评估中的研究进展作一综述。     

Challenges and outcomes in establishing a sentinel lymph node biopsy service for oral squamous cell carcinoma in a regional district specialist hospital

UK national guidelines in 2016 recommended that sentinel lymph node biopsy (SLNB) should be offered to patients with early oral squamous cell carcinoma (OSCC). We review the establishment of an OSCC SLNB service with specific consideration to resources, service implications and patient outcomes. A review of processes was performed to identify key stages in establishing the service, and subsequently a retrospective cohort study consisting of 46 consecutive patients with T1/T2 N0 OSCC was undertaken. The key stages identified were: coordinating a nuclear medicine pathway and reliable cost-appropriate pathology service, constructing a Trust business case, and gaining approval of a new interventional service policy. A median (range) of 3.3 (1-8) sentinel nodes (SLN) were removed, with 17 patients having a positive SLN. The negative predictive value of SLNB was 100%, with 12 having a SLN outside the field if elective neck dissection (END) was planned. There was a significantly increased risk of a positive SLN with increasing depth of invasion (DOI) (p=0.007) and increased diameter (p=0.036). We also identified a longer-than-ideal time to completion neck dissection and inadequate ultrasound follow up of negative SLNB patients. Establishment of a service requires careful planning. Our results were in keeping with those reported in the literature, and showed that SLNB for OSCC has a high negative predictive value and can identify at-risk SLN outside the traditional END levels, even in well-lateralised tumours. Our findings show that DOI and size of SLN were significantly associated with a positive SLN, and also identified areas requiring improvement.     

唾液腺腺样囊性癌淋巴结转移相关的研究进展

唾液腺腺样囊性癌(salivary adenoid cystic carcinoma,SACC)是一种常见的唾液腺恶性肿瘤,恶性度高,局部复发和远处转移是SACC患者常见的死亡原因.传统上认为淋巴结转移在SACC患者中并不常见,然而由于文献报道的转移发生率差别很大,SACC患者颈部治疗方案仍有争议,且SACC术中淋巴结...     

PET/CT在诊断口腔颌面部肿瘤颈淋巴结转移中的价值

目的:通过与MRI检查比较,评价PET/CT(integrated PET-CT system)在诊断口腔颌面部肿瘤颈部淋巴结转移中的临床价值.方法:前瞻性分析2008-2011年47例口腔颌面部肿瘤患者,于术前2周内分别进行PET/CT、MRI检查.分别获取PET/CT影像和MRI影像.以病理结果为金标准,分析2种方法判断颈部淋巴结转移的敏感度、特异度及准确率方面的差异.采用SPSS13.0软件包对数据进行x2检验.结果:PET/CT、MRI判定颈淋巴结转移的敏感度分别为89.5％和73.7％(P＜0.05);特异度分别为89.3％和78.6％(P＞0.05);准确率分别为89.4％和76.6％(P＜0.05).结论:PET/CT在口腔颌面部肿瘤颈部淋巴结转移判定中的敏感度及准确率均优于MRI,差异具有统计学意义;PET/CT在口腔颌面部肿瘤颈淋巴结转移判定中作为一种辅助诊断方法,具有重要的临床价值.     

Morphological changes of regional lymph node in squamous cell carcinoma of the oral cavity

BACKGROUND: Regional immune responses with various types of cancer have been studied histopathologically, however, the prognostic value remains conflicting. The aim of this study was to evaluate morphological changes related to lymph node metastasis and the prognostic value for oral cavity squamous cell carcinoma. METHODS: With histopathologic whole architecture of 430 lymph nodes, gross area, germinal center (GC) area, paracortical area (PA), and tumor area were measured. RESULTS: Metastatic node had significantly lower distribution ratio of PA to lymphoarea than that of tumor-free node. GC area was not constantly associated with lymph node metastasis. In Cox multivariate analysis, the mean ratio of PA to gross area/lymphoarea was an independent prognostic factor. CONCLUSIONS: The proportion of PA to gross/lymph area was associated with lymph node metastasis and long-term survival and may be useful in stratification of those patients for a requirement of adjuvant treatments.