cN0口腔癌患者行单纯原发灶切除后颈淋巴结转移情况的临床分析

目的 分析cN0口腔癌患者行单纯原发灶切除后颈淋巴结的转移情况及发生转移的影响因素。方法回顾性分析2005年5月至2015年5月期间行单纯原发灶切除治疗的105例cN0口腔癌患者的病历资料,以颈淋巴结转移率为主要评价指标,使用Kaplan-Meier法和log-rank检验对患者的颈淋巴结转移情况及其影响因素进行分析。结果 105例cN0口腔癌患者中有34例（32.38%）在随访期内出现颈部淋巴结转移,患者最早在术后3个月出现颈淋巴结转移体征,最晚为术后18个月,术后3～12个月为颈淋巴结转移的高发时段。年龄、性别、肿瘤病程、肿瘤部位、肿瘤大小及病理分化等因素均不是影响颈淋巴结转移的危险因素（P> 0.05）。结论 cN0口腔癌患者行单纯原发灶切除后有较高的比例出现颈淋巴结转移,转移规律有较强的隐匿性和复杂性,目前仍缺乏有效的因素来预测。     

合理的根治性颈淋巴清扫术的临床应用评价

目的:评价保留颈外静脉、耳大神经和颈神经丛深支的新型改良根治性颈淋巴清扫术(或称合理的根治性颈淋巴清扫术)在治疗口腔癌颈淋巴转移灶中的临床应用价值。方法:TNM分期在T2N1M0~T4N3M0之间的口腔鳞癌初诊患者45例,随机分为2组(RND组和RRND组),RND组行传统根治性颈淋巴清扫术(22例),RRND组行合理的根治性颈淋巴清扫术(23例),比较2种手术方式的颈淋巴结术后复发率和并发症。结果:RRND组术后患者面部水肿及头晕、头痛症状显著低于RND组(P<0.05);术后6个月复查,RRND组患者耳廓和肩部麻木感显著低于RND组,耳廓皮肤感觉功能和肩运动功能显著高于RND组(P<0.05);随访3年,RRND组和RND组术后颈淋巴结复发率分别为8.70%、4.55%,差别无统计学意义(P>0.05)。结论:合理的根治性颈淋巴清扫术与传统根治性颈淋巴清扫术相比,不会增加术后颈淋巴结复发率,但极大地提高了患者术后的生存质量。     

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     

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。     

54例口腔癌颈淋巴结转移的临床分析

探索颈部为 N0 或 N1 a的口腔癌的最佳治疗方式。方法　回顾分析我院 1990年 5月～ 1999年2月间 5 4例颈部为 N0 或 N1 a的口腔癌根治术后颈淋巴转移患者的临床资料。结果　 5 4例颈淋巴为 N0 或 N1 a的口腔癌的颈淋巴转移率为 42 .5 % ,主要集中在颌下区淋巴结。T3、T4的颈转移率为 72 .1% ,转移部位主要是颌下区和颈深上区的角淋巴区 ;另外还有 5 .5 %的跳跃性颈淋巴转移。高转移癌是舌、颊癌。结论　对于临床分期为 N0 的或N1 a各类口腔癌 ,治疗方式要结合口腔癌的部位 ,T分期、年龄及全身情况来决定。T3、T4的 N0 口腔癌应常规同期行功能性肩胛舌骨上清扫术 术后辅助根治性放疗。而 T1 、T2 的 N0 口腔癌中 ,有高转移倾向的舌、颊癌应行扩大舌骨上清扫术。     

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。     

肩胛舌骨上颈清扫术对cN0口腔癌患者颈部复发影响的Meta分析

目的:评价肩胛舌骨上颈清扫术对cN0口腔癌患者颈部转移及复发的影响。方法:评价国内外1985～2004年公开发表的关于肩胛舌骨上颈清扫术与根治性颈淋巴清扫术对cN0口腔癌患者颈部转移及复发影响的对照研究,研究组接受肩胛舌骨上颈清扫术,对照组为根治性颈淋巴清扫术,结局变量为研究组与对照组颈部区域转移及复发率,应用RevMan4.2.2进行Meta分析。结果:肩胛舌骨上颈清扫组的转移及复发优势比OR=1.34,95%置信区间[0.74,2.43],表明肩胛舌骨上颈清扫组与根治性颈清扫组比较,对cN0口腔癌患者术后颈部转移及复发影响的差异无统计学意义。结论:对于cN0口腔癌患者的颈部淋巴结处理,肩胛舌骨上颈淋巴清扫术与根治性颈淋巴清扫术的治疗效果一样,无显著差异。但由于某些偏倚因素可能影响结果,此结论仅供参考,尚需待新研究出现时予以再次论证。     

单侧颈淋巴清扫术应用各种麻醉方法的体会(附262例)

颈淋巴清扫术是控制口腔颌面部癌肿经颈淋巴结转移的有效方法之一。视原发灶及区域淋巴结的不同情况,可分为颈上部淋巴清扫术、单侧及双侧颈淋巴清扫术;以及选择性或治疗性淋巴清扫术。临床上多为单侧颈淋巴清扫术与原发灶同时大块切除的联合     

112例口腔癌颈淋巴清扫术的临床评价

目的 探讨口腔癌患者颈淋巴结清扫术的适应症。方法 研究112例口腔癌患者的术后淋巴结病理切片，分析淋巴结转移与肿瘤原发部位、体积大小、分化程度的关系。结果 腭、上颌骨、舌等部位肿瘤转移率较高，颈淋巴转移和肿瘤大小、表面积成正相关，和分化程度戍负相关，颈淋巴状况对判断颈淋巴结有无转移作用不大。结论 临床资料结合CT、MRI、细胞学穿刺检查可为选择颈淋巴清扫术提供参考，减少临床上手术过度。     

舌体鳞癌cN0患者颈淋巴转移相关因素分析及其处理

目的　探讨舌体鳞癌cN0 患者的颈部处理。方法　舌体鳞状细胞癌共 1 85例 ,男性 1 0 2例 ,女性 83例 ,年龄 2 8～ 88岁。所有病例均行原发灶手术切除 +颈淋巴清扫术。原发灶及颈淋巴结全部术后病理证实。结果　Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者颈淋巴结转移率分别为 1 6 66 %和 38 0 5 % ;1 4 8例cN0 患者鳞癌Ⅰ级和Ⅱ级颈淋巴结转移率分别为 1 7 42 %和 37 50 % ;原发灶侵及粘膜下层、肌层和神经者 ,其颈淋巴结转移率分别为 9 0 0 %、31 37%和 55 55 %。 1 85例患者 5年生存率为 72 43 % ,其中颈淋巴有转移和无转移者 5年生存率分别为 44 44%、83 96 %。 1 4 8例cN0 患者颈淋巴结阳性者 2 9例 ,其转移区 :下颌下 +颏下 (Ⅰ )占 2 2 64 % ,颈深上 (Ⅱ )占 35 84% ,颈深中 (Ⅲ )占 2 6 40 % ,颈深下(Ⅳ )为 1 5 0 9% ,颈后 (Ⅴ )为 0 %。选择性颈淋巴清扫术 5年生存率为 85 1 3 % ,治疗性为 2 1 62 %(χ2 =2 9 73 ,P <0 0 1 )。选择性颈淋巴清扫术病例中 ,有淋巴结转移 5年生存率为 68 96 % ,未见淋巴结转移者 5年生存率为 89 0 7%。选择性颈淋巴清扫术有淋巴结转移 5年生存率为 68 96 % ,而治疗性有淋巴结转移 5年生存率仅 2 0 0 % (P <0 0 1 )。结论　①cN0 患者除早期 (Ⅰ期 )可行颈部观察 ,Ⅱ～Ⅳ期须     

Relevance of level IIb neck dissection in oral squamous cell carcinoma

Background

The purpose of this study was to determine the prevalence of level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs).

Material and Methods

A prospective analysis of 56 patients with OSCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection was performed. During neck dissection, level IIb lymph nodes were separately removed and processed. Neck dissection was bilateral in 26 patients (46%) and unilateral in 30 patients (54%).

Results

The mean number of nodes found in the level IIb specimens was 4.7 (range: 0-8 nodes). The prevalence of metastasis at level IIb was 0% in pN0 necks and 3.4% in pN+ necks, with an overall prevalence of 1.8%. A significant association between metastasis to level IIb and type of neck dissection was observed. There were no isolated metastases to level IIb without the involvement of other nodes in the remaining neck specimen. Four regional recurrences were observed during follow-up.

Conclusions

Based on our findings, we suggest that dissection of the level IIb region in patients with OSCC may be required only in patients with multilevel neck metastasis or if level IIa metastasis is found intraoperatively. Key words: Oral squamous cell carcinoma, neck dissection, level IIb, metastasis, spinal accessory nerve.     

功能性与根治性颈淋巴清扫术在早期口腔鳞状细胞癌治疗中的疗效比较

目的:探讨功能性颈淋巴清扫术(functional neck dissection,FND)与根治性颈淋巴清扫术(radical neckdissection,RND)在口腔鳞状细胞癌中的临床疗效.方法:63例口腔鳞状细胞癌患者,分为FND组(n=30)和RND组(n=33),FND组保留胸锁乳突肌、副神经、颈内静脉及耳大神经,术后随访2组患者的肩外展功能、耳大神经功能、颈部是否明显凹陷及颈部复发率.应用SPSS 18.0软件包对数据进行单因素x2检验、两独立样本均数t检验,以及Fisher确切概率检验.结果:FND与RND组之间在年龄、性别、肿瘤部位、T分期、N分期、组织学分化程度、病理学类型、术前化疗及术后化疗等方面无显著差异(P＞0.05).所有患者均为N0或N1期,FND组术后肩关节活动度、耳垂感觉麻木及颈部凹陷改善程度显著优于RND组(P＜0.05);术后随访2年,FND组的颈部复发率与RND组无显著差异(P=1.000).结论:对于N0或N1期口腔鳞状细胞癌患者,FND与RND相比,患者颈部复发率无显著差异,但其并发症显著减少,可明显提高患者术后的生活质量.     

美蓝在口腔鳞状细胞癌前哨淋巴结活检中的应用

目的：探讨美蓝在口腔鳞状细胞癌前哨淋巴结（sentinel lymphnode,SLN）活检中的应用,为临床N0患者是否作颈部淋巴结清扫提供依据。方法：用美蓝对30例口腔鳞状细胞癌临床N0患者行前哨淋巴结定位活检,通过与区域淋巴结清扫标本的比较来评价前哨淋巴结活检的准确性。结果：前哨淋巴结定位活检总成功率为93.3%（28/30）,准确率92.9%（26/28）,假阴性率为11.1%（2/18）,灵敏度为83.3%（10/12）,特异性100%（16/16）。结论：前哨淋巴结活检在口腔鳞状细胞癌中能很好地反映淋巴结的转移情况,对指导淋巴结清扫的合理性和必要性有一定的临床应用价值。     

颊黏膜鳞癌颈淋巴结隐匿性转移的临床研究

目的:探讨颊黏膜鳞癌隐匿性转移规律。方法:1992-01～2004-12月在南京大学口腔医院口腔颌面外科行颈淋巴清扫术的颊黏膜鳞癌cN0患者69例,男性31例,女性38例,年龄31～79岁,平均58.2岁。颈部的处理采用根治性颈淋巴清扫术、功能性颈淋巴清扫术或肩胛舌骨上颈淋巴清扫术。结果:颊黏膜鳞癌颈淋巴结隐匿性转移率为14.49%(10/69),转移到Ⅰ区为10.14%(7/69)、Ⅱ区为5.80%(4/69)、Ⅲ区为2.90%(2/69);T1颈部隐匿性转移率为9.52%(2/21)、T2为15.38%(6/39),T3、T4例数较少,其中4例T3中有1例转移,5例T4中有1例转移;高、中分化鳞癌颈部隐匿性转移率分别为14.89%(7/47)、10.00%(2/20),低分化鳞癌例数较少,2例中有1例转移。结论:认识颊黏膜鳞癌颈部淋巴结隐匿性转移特征,对制定颈部治疗方案具有重要意义。     

Metastasis of maxillary carcinoma to the parapharyngeal space: rationale and technique for concomitant en bloc parapharyngeal dissection.

PURPOSE: En bloc resection of the primary tumor and regional lymph nodes is the classic method of surgery in cases of head and neck cancer, but it is not performed in cases of carcinoma of the maxillary gingiva or antrum for anatomic reasons. One of the reasons for the poor prognosis of patients with maxillary cancer and N+ stage necks is thought to be recurrence in the parapharyngeal space, which is out of the surgical field in radical neck dissection. The purpose of this study was to discuss the rationale and indication for en bloc resection and parapharyngeal dissection for maxillary cancer. PATIENTS AND METHODS: Ninety-nine patients with maxillary cancer (54 in the gingiva and 45 in the antrum) treated at our institution between 1980 and 2000 were studied retrospectively. RESULTS: In 4 patients, there was recurrence in the parapharyngeal spaces despite good control of tumors in the maxilla and the neck. These 4 patients had all undergone resection of maxilla and neck lymph nodes separately. We also report the case of a patient with carcinoma of the maxillary antrum who underwent en bloc resection of the maxilla and neck. After radical neck dissection, parapharyngeal dissection was performed with a mandibular ramus osteotomy approach, and the maxilla and neck tissue were resected en bloc. CONCLUSIONS: Although en bloc resection causes more extensive surgical damage, it may be useful in patients with maxillary cancer who have metastasis in the upper jugular lymph nodes.     

Salvage neck dissections in oral and oropharyngeal squamous cell carcinoma: histological features in relation to disease category

The histological findings in a series of 37 salvage neck dissections from patients who had an oral or oropharyngeal squamous cell carcinoma managed initially by primary surgery with or without neck dissection, and without postoperative radiotherapy, are described. None of the cases had an intraoral relapse. Pathological stage N2 or N3 disease was seen in 87% of the 15 salvage dissections from 'wait and watch' necks, 100% of the 10 salvage dissections of contralateral necks and 50% of the 12 salvage dissections of operated necks. The typical 'inverted-cone' pattern of metastasis was seen in 87% of 'wait and watch' necks. Skip or non-contiguous metastases to level III/IV accounted for relapse in 30% of the contralateral and 66% of the operated necks. The median time interval between original surgery and the salvage neck dissection was 15 months (range 1-48 months). In at least 15% of cases, the short time interval coupled with the histopathological features suggested that the metastatic disease suddenly became more rapidly progressive following removal of the primary tumour.     

The significance of DNA flow cytometry in predicting survival and delayed clinical manifestation of occult lymph node metastasis to the untreated neck in patients with oral squamous cell carcinoma

A total number of 116 clinically neck-negative patients with squamous cell carcinoma of the oral cavity who underwent radical primary tumour surgery without simultaneous neck treatment were entered into this prospective study. The 5 year overall survival rate was 87% for patients with flow cytometrically diploid tumours and 58% for the aneuploid group (P < 0.05). By multivariate survival analysis, tumour stage (P < 0.05) and DNA ploidy (P < 0.05) were significantly associated with the outcome. The cumulative 3 year rate of delayed clinical manifestation of lymph node metastasis to the previously untreated neck was 12.6% for patients with flow cytometrically diploid tumours and 41.3% for the aneuploid group (P < 0.01). By multivariate analysis, the DNA ploidy status of the primary tumour was the only factor among tumour stage, localization and degree of histological differentiation predictive of occult metastasis development (P < 0.05). Also, patients with T1 tumours who frequently are not considered to benefit from elective neck dissection were at high risk of subclinical lymph node involvement if the primary tumours were aneuploid (47%), whereas only 10% of the diploid T1 sample showed occult neck disease. Particularly in patients with less extensive oral carcinomas, DNA aneuploidy is therefore an important decisive factor in elective neck dissection.     

口底区域淋巴组织清扫术在舌癌根治术中的应用

目的:为减少舌癌患者术后复发率及转移率,探讨口底区域淋巴组织清扫术的范围、术式及其临床意义。方法:收集随访2000年5月～12月本科舌癌手术患者20例(原发灶T2或T3,未明显侵犯口底,颈部N0)。同期舌-(颌)-颈联合根治术,术中于颏孔前断离并外展下颌骨,以利直视下彻底清扫同侧口底中间带淋巴组织,达到完整舌-(颌)-颈根治。同期调查我院和外院舌癌手术后患者20例(术中口底中间带淋巴组织保留或未彻底清扫)作为对照,比较两组患者复发率与颈部淋巴结转移率。结果:实验组局部无1例复发,对侧淋巴结转移2例(T3),转移率10%。对照组口底或下颌下复发7例,对侧颈淋巴转移5例,复发转移率60%。P<0.05,有统计学显著性差异。结论:传统非连续性颈清扫并不能清除所有可能受累的淋巴结。对T2以上的舌癌患者,宜在传统的颈清术式基础上,断离、外展下颌骨,行同侧口底中间带组织的彻底清扫。     

Effectiveness of lymphoscintigraphic sentinel node detection for cervical staging of patients with squamous cell carcinoma of the head and neck.

PURPOSE: To evaluate the feasibility and staging ability of the sentinel node (SN) technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. This prospective study compares the histopathologic status of the SN with that of the remaining neck dissection tissues. PATIENTS AND METHODS: Thirty previously untreated patients with T1 to T4 squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks (N0) were included in the study. Injection of 99m Tic-radiolabeled sulfur colloid around the primary tumor and lymphoscintigraphy were performed the day before surgery. Intraoperatively, the SN(s) was localized with a gamma probe and removed during neck dissection. The tumor was resected at the same time. RESULTS: For 1 patient, lymphoscintigraphy revealed no SN. SN were identified in 29 patients/37 necks. In 29 necks, there were no positive SN. In 5 patients, the SN was the only histopathologically positive node. In 1 patient, SN and other nodes in the remaining neck tissue were positive. There was 1 false negative case; the first case of the study, indicating the need for a learning curve for the technique. CONCLUSION: This prospective study shows that the SN is useful for the staging of N0 necks. The SN technique has the potential to decrease the need for neck dissections, which are usually performed in clinically negative necks, thus reducing both associated morbidity for patients and cost.