根治性颈清扫术对肩功能的影响

目的　分析研究根治性颈清扫术后发生的肩综合征对患者生活、工作的影响,进一步研究探讨科学合理的评价标准。方法　对50例根治性颈清扫术(RND)患者通过主观评价和客观检查进行回顾性分析。结果　68％患者认为RND对生活和工作有较大妨碍,所有RND患者术后均有不同程度的肩功能障碍。结论　RND后均有不同程度的肩功能障碍,并对患者生活质量产生较明显的影响。通过患者自我评价可较好地了解RND对生活质量的影响;用上肢外展能否大于90°来评价颈清扫术后肩功能恢复程度,是科学合理的。     

2种颈淋巴清扫术对口腔鳞状细胞癌cN0期患者疗效的对比分析

目的 对比分析肩胛舌骨上颈淋巴清扫术(supraomohyoid neck dissection,SOND)和传统根治性颈淋巴清扫术(classical radical neck dissection,CRND)对口腔鳞状细胞癌cN0期患者术后颈部复发率、生存率和生存质量的影响。方法 68例临床cN0期的口腔鳞癌患者随机分为2组:CRND组和SOND组均为34例。统计比较术后颈部复发率,应用SPSS10.0软件统计分析2组患者术后3年、5年生存率,用华盛顿大学生存质量问卷评价两组患者的生存质量。结果 CRND组和SOND组3年颈部复发率分别为8.8%、11.7%,5年颈部复发率分别为11.8%、14.7%;CRND组和SOND组3年生存率分别为69.1%、68.4%,5年生存率分别为55.6%、54.9%;CRND组和SOND组生存质量平均总分各为533.57±112.22,653.06±84.92,有统计学差异。因而对cN0期的口腔鳞癌患者行肩胛舌骨上颈淋巴清扫术与传统根治性颈淋巴清扫术相比,没有降低患者术后生存率和颈部复发率,但显著地提高了患者术后的生存质量。结论 肩胛舌骨上颈淋巴清扫术在cN0期口腔鳞癌患者的治疗上可以取代传统根治性颈淋巴清扫术。     

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。     

cN0口腔鳞状细胞癌颈部淋巴结转移的临床分析

目的:探讨颈部淋巴结阴性(c N0)的口腔鳞癌(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2008-07~2013-07接受颈淋巴结清扫的85例c N0 OSCC患者的临床和病理资料进行回顾性分析。结果:85例c N0 OSCC患者中,总隐匿性转移率为28.24%(24/85)。c N0 OSCC患者淋巴结转移率与性别、发病部位无相关性(P>0.05),与年龄、原发灶大小、病理分期及生长方式存在显著相关性(P<0.05)。结论:肿瘤体积越大、分化程度越低、患者年龄越小其淋巴结隐匿性转移率越高,对此类患者需积极行相应颈部淋巴结清扫处理。     

纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌颈淋巴清扫术中的应用

目的 探讨纳米炭淋巴结示踪剂在cN0舌鳞状细胞癌患者颈淋巴清扫术中的应用价值。方法 选取96例cN0舌鳞状细胞癌患者作为研究对象,随机分为纳米炭组（试验组,50例）和对照组（46例）,其中纳米炭组患者于术前12 h在距离肿块边缘0.5 cm处黏膜下多点注射纳米炭混悬注射液（每个注射点0.1 mL,共计3~4个注射点）。根据原发肿瘤的大小及部位选择行肩胛舌骨肌上（Ⅰ~Ⅲ区）或全颈（Ⅰ~Ⅴ区）淋巴清扫术。标本离体后解剖、分离所有淋巴结,并行病理学检查,记录检获的淋巴结数目、大小、部位、病理结果。将试验组与对照组所得数据进行比较,采用SPSS 19.0统计软件包进行统计学分析。结果 31例患者行肩胛舌骨肌上颈淋巴清扫术,共检出淋巴结1 137枚,纳米炭组平均每例检出淋巴结数（43.79±19.23）枚,显著高于对照组的（30.82±8.77）枚（P=0.019）,两组均以Ⅲ区检出的淋巴结数最多,但纳米炭组Ⅱ区检出的淋巴结数及构成比均显著高于对照组（P=0.000）。65例全颈淋巴清扫术共检出淋巴结3 938枚,纳米炭组平均每例检出淋巴结数为（66.67±20.02）枚,对照组为（53.03±20.98）枚,两组差异有统计学意义（P=0.026）,两组在各区（Ⅰ~Ⅴ区）检出淋巴结数的构成比的差异无统计学意义（P=0.354）。两种颈淋巴清扫术式中,纳米炭组检出微小淋巴结的比例和检获淋巴结的准确率均高于对照组（P=0.000）;纳米炭组中染色淋巴结癌转移的检出率高于未染色的淋巴结（P=0.000）。结论 纳米炭淋巴结示踪剂可以显著提高cN0舌鳞状细胞癌患者颈淋巴清扫术中淋巴结特别是微小淋巴结的检出率,有助于提高颈淋巴清扫术的彻底性和患者临床病理分期的准确性。     

cN0口腔鳞癌患者Ⅱb区淋巴结转移102例研究

目的 ：统计cN0口腔鳞状细胞癌（oral squamous cell carcinoma, OSCC）患者Ⅱb区淋巴结转移情况,从而探讨择区性颈淋巴结清扫（selective neck dissection, SND）时处理Ⅱb区域的必要性。方法：收集我院口腔颌面外科2014年1月—2015年7月行颈淋巴结清扫术及原发灶手术治疗的cN0 OSCC患者的资料,共102例（102侧）,并统计患者Ⅰ～Ⅳ区淋巴结转移情况,记录所有患者术前,术后1～2个月、3～5个月、1年、2年和5年的肩功能、生存质量[美国华盛顿大学生存质量问卷（the University of Washington quality of life questionnaire, UW-QOL questionnaire）]情况及转移情况。结果：90例行肩胛舌骨肌上颈淋巴结清扫术（supraomohyoid neck dissection, SOND）,12例行Ⅰ～Ⅳ区择区性颈淋巴结清扫术。102例OSCC患者中,淋巴结转移以Ⅰb、Ⅱa、Ⅲ区多见,Ⅱb和Ⅳ区少见。单独发生在Ⅱb区的转移淋巴结仅有1例患者。术后2周内,大多数患...     

cN0期上颌鳞状细胞癌的诊断与治疗进展

上颌鳞状细胞癌相对于口腔其他部位的鳞癌发病较少,传统认为其颈部的淋巴结转移率较低,特别是c N0期的肿瘤,在治疗方式上也没有形成统一的认识。近年来,随着新技术的发展及上颌鳞状细胞癌c N0期研究的增多,我们对上颌鳞状细胞癌c N0期的认识也有所增加。本文将现阶段上颌鳞状细胞癌c N0期的颈部淋巴结隐匿性转移情况、检查方式及治疗进展作一综述。     

颈清扫术几种改进术式的比较研究

目的 通过两种改进颈清扫术式MRND与RND和FND术后肩功能的比较研究,观察MRND1和MRND2能否较好地保留或恢复斜方肌的功能。方法46例需行颈清扫术的患者,分成4组,分别行RND、FND和MRND1、MRND2,通过肩功能临床检查的主客观评价标准及斜方肌肌电检测进行对比研究。结果MRND1和MRND2均可获得较大程度的斜方肌功能恢复,MRND1和MRND2的上肢平均最大外展角度分别为96.67°和98.13°,50％的患者外展上臂超过90°,两种改进术式的术后肩功能明显优于RND。结论MRND1和MRND2较FND有广泛的适应证,又可较大程度地保存和恢复术后斜方肌的功能,改善传统RND术后的肩综合征,临床上可以用来代替传统RND,以提高患者的生存质量。     

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。     

Neck dissection with the harmonic scalpel in patients with squamous cell carcinoma of the oral cavity

Our purpose was to evaluate the use of the Harmonic scalpel in neck dissections.Material and methodsWe conducted a randomized prospective intervention study to compare the Harmonic scalpel (32 patients) with the conventional technique (31 patients).ResultsOperative time was lowered by 64 min (p < 0.001) and 7.5 min (p = 0.367); blood lost during surgery was lowered by 80.5 ml (p < 0.001) and 76.6 ml (p < 0.001); the length of time the drains were kept in place was lowered by 1.3 days (p < 0.001) and 1.5 days (p < 0.01); and the volume of drainage was lower by 228.7 ml (p < 0.001) and 187.6 ml (p < 0.01) in selective and comprehensive neck dissections respectively in patients treated with the Harmonic scalpel.ConclusionsThe Harmonic scalpel shortens operative time in selective dissections. It reduces blood loss during surgery; time drains are kept in place and the amount of drainage in comprehensive and selective neck dissections.     

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.     

Supraomohyoid neck dissection and modified radical neck dissection for clinically node-negative oral squamous cell carcinoma: A prospective study of prognosis,complications and quality of life

BackgroundTo assess the prognosis and morbidity between supraomohyoid neck dissection (SOND) and modified radical neck dissection (MRND) for oral squamous cell carcinoma (OSCC) in patients with a clinically node-negative neck (cN0).Patients and methodsThis prospective randomized study began in June 1999, and patient accrual concluded in May 2010. The cN0 neck was confirmed on clinical palpation by senior doctors. Ultimately, there were 322 patients recruited into the study.ResultsPatient demographics were well balanced between the two groups. There were 10 patients in the SOND group and 21 patients in the MRND group who developed nodal recurrence without associated local recurrence or distant metastasis. The 3-year neck control rate (NCR) rate was 92.6% for the SOND group and 87.5% for the MRND group (in favor of SOND, P = 0.108). There was no significant difference between the SOND group and the MRND group in the 3-year disease-specific survival (DSS) rate (79.0% vs. 76.9%, P = 0.659). Importantly, there were significantly fewer complications in the SOND group compared with the MRND group (13.0% vs. 21.9%, P = 0.040). The disease-free survivors in the SOND group also reported better pain relief (P = 0.013) and shoulder function (P < 0.001) than those in the MRND group one year after treatment.ConclusionsWe recommend SOND as a priority treatment for cN0 OSCC patients.     

58例舌鳞癌患者术后生存质量及功能评价

目的：评价58例舌鳞癌患者术后的生存质量。方法：对58例舌鳞癌术后患者进行UW-QOL量表的问卷调查,比较舌鳞癌手术切除后胸大肌皮瓣修复及非皮瓣修复、功能性颈清扫术及根治性颈清扫术等不同手术方法对患者生存质量的影响；对患者日常生活的9个选项结果进行成组t检验,观察是否存在统计学差异。结果：组织瓣修复组和功能性颈清扫术组的生存质量总分高于非组织瓣组和根治性颈清扫术组,其差异具有统计学意义(P＜0．01)；在外貌及语言清晰度方面,组织瓣组的生存质量分数高于非组织瓣组,差异具有显著性(P＜0．01)。而在肩部功能方面,功能性颈清扫术的生存质量分数高于根治性颈清扫术,两者之间具有显著性差异(P＜0．01)；疼痛方面,非组织瓣组显著优于组织瓣组(P＜0．01)。结论：应用组织瓣对舌鳞癌切除后进行修复,在外貌和语言交流方面可以提高患者的生存质量：而术后患者的肩功能状况,功能性颈清扫术优于根治性颈清扫术。     

Surgery for maxillary oral squamous cell carcinoma: the effect of surgical resection margins and elective neck dissection on oncological outcomes

Maxillary oral squamous cell carcinoma (OSCC) is uncommon. Surgical resection is challenging due to the anatomy, and the role of elective neck dissection (END) is not well-defined. A retrospective cohort study of patients with maxillary OSCC treated with primary surgery between 2007 and 2019 was conducted. Primary tumours of sinonasal origin with extension into the oral cavity were excluded. Survival analysis was performed using Kaplan–Meier and Cox proportional hazards models. Sixty-seven patients were included; mean follow-up was 55 months. On univariate analysis, clear (≥5 mm) margins were associated with higher disease-free (68% vs 36%, P = 0.019) and overall survival (75% vs 36%, P = 0.004) than close/involved (<5 mm) margins. In clinically node-negative patients, the risk of occult cervical metastasis in tumours with depth of invasion (DOI) ≥ 3 mm and T2–4 tumours was 22% and 25%, respectively. END in these groups was associated with a lower rate of loco-regional recurrence (DOI ≥3 mm subgroup: 5% vs 38%, P = 0.029; T2–4 subgroup: 6% vs 50%, P = 0.028) and longer time to recurrence (DOI ≥3 mm subgroup: 119 months vs 96 months, P = 0.042; T2–4 subgroup: 117 months vs 56 months, P = 0.031) than observation of the neck. On multivariate analysis, close/involved margins were associated with an increased risk of overall mortality (hazard ratio 3.4, 95% confidence interval 1.0–11.3, P = 0.043) and disease recurrence (hazard ratio 2.8, 95% confidence interval 1.1–7.1, P = 0.031). In maxillary OSCC, a ≥ 5 mm histological margin should remain the goal of ablative surgery. END should be considered in tumours with DOI ≥ 3 mm.     

口腔疣状癌与口腔鳞状细胞癌差异基因表达的对比分析

目的研究口腔疣状癌与口腔鳞癌组织基因的差异表达，探讨口腔疣状癌（oral Verrucous carcinoma，OVC）与口腔鳞癌（oral squamous cell carcinoma，OSCC）的基因学基础。方法应用cDNA芯片技术对4例OVC和4例OSCC组织mRNA检测，通过芯片杂交、生物信息学处理，找出两者间差异表达基因。结果BioStarH-40芯片发现差异表达基因593条，差异表达基因占15．2％，其中表达增强283条（显著增强59条），表达降低310条（显著降低98条）。结论OVC与OSCC基因表达比较，差异有统计学意义，这些差异可能在各自不同的生物学行为中起重要作用。     

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.     

Selective versus comprehensive neck dissection in the treatment of patients with a pathologically node-positive neck with or without microscopic extracapsular spread in oral squamous cell carcinoma

The objective of this study was to compare the prognosis and complications between selective neck dissection (SND) and comprehensive neck dissection (CND) for patients with a pathologically node-positive neck in squamous cell carcinoma of the tongue and the floor of the mouth. This was a retrospective cohort study. There was no significant difference between the SND group and the CND group in 3-year neck control rate (86.2% vs. 85.9%, P = 0.797) or disease-specific survival (DSS) rate (64.6% vs. 61.9%, P = 0.646). Further analyses of the respective 3-year DSS rates in the SND and CND subgroups were as follows: pN1 without extracapsular spread (ECS), 67.7% vs. 72.2%, P = 0.851; pN2b without ECS, 64.7% vs. 68.8%, P = 0.797; and pN+ with ECS, 57.1% vs. 60.0%, P = 0.939. Of note, there were significantly fewer complications in the SND group compared with the CND group (7.3% vs. 20.0%, P = 0.032). Multivariate analysis showed that the modality of neck treatment, pN+ status, and microscopic ECS did not serve as independent prognostic factors. SND plus adjuvant radiotherapy is a management strategy of high efficiency and minor morbidity for selected oral cancer patients with a pN+ neck with or without microscopic ECS.     

Assessment of shoulder function after functional neck dissection and selective neck dissection (Levels I, II, III) in patients with carcinoma of tongue: a comparative study

Background and objectives  

To compare shoulder function with respect to pain and disability in patients who have undergone nerve sparing neck dissection i.e. selective neck dissection (levels I, II, III) and functional neck dissection as a part of their treatment modality for carcinoma tongue on a follow up of minimum six months.