口腔颌面部肿瘤患者T淋巴细胞亚群的检测及其与临床预后关系的研究

目的：了解口腔颌面部鳞癌患者细胞免疫功能状态。方法：应用流式细胞术对19例口腔颌面部鳞癌患者及10例正常人外周血中T淋巴细胞亚群水平进行了检测。结果：口腔颌面部鳞癌患者外周血中的CD3细胞数较健康人低下（P＜0．05），CD4、CD4／CD8下降，而CD8升高。晚期、分化差及有颈淋巴结转移的患者，其CD3、CD4、CD4／CD8较早期、分化好及无颈淋巴结转移的患者低，而CD8则相对较高。结论：口腔颌面部鳞癌患者的细胞免疫功能低下，且可能与肿瘤的临床分期及病理分级有一定的关系。     

口腔颌面部恶性肿瘤颈淋巴结转移的外科诊治指南

口腔颌面部恶性肿瘤具有较高的淋巴道转移倾向，颈部淋巴结转移的诊断和治疗是口腔颌面部肿瘤治疗中的重要内容。为与国际接轨，统一国内诊治标准，便于学术交流，特制定口腔颌面部不同部位及不同病理类型肿瘤颈淋巴结转移的诊治指南。     

口腔颌面部鳞状细胞癌颈淋巴结转移超声诊断标准

本文通过回顾性研究得出口腔颌面部鳞状细胞癌颈淋巴结转移的超声诊断标准,并在前瞻性研究中进行检验。 材料和方法 41例口腔颌面部鳞状细胞癌患者术前接受颈淋巴结超声波检查,作出每个患者所检查的颈淋巴结分布图,并记录淋巴结的最大直径、最小直径、形状指数、边缘特征、内部回声的形态及致密度、是     

基质金属蛋白酶-2与口腔鳞癌颈淋巴结转移关系的研究

目的：探讨基质金属蛋白酶－2与口腔鳞癌颈淋巴结转移的关系。方法：通过蛋白酶谱法对口腔鳞癌（OSCC）癌组织，正常口腔粘膜组织及血浆中基质金属蛋白酶－2（MMP－2）含量进行了研究，并与口腔鳞癌的临床病理特征进行统计学分析。结果：口腔鳞癌OSCC癌组织，正常口腔粘膜及血浆中均存在MMP－2，而OSCC癌组织及血浆中MMP－2含量升高与OSCC的颈淋巴结转移有关；OSCC癌组织中MMP－2含量高于正常口腔粘膜组织，结论：MMP－2可判断口腔鳞癌颈淋巴结转移的指标。     

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.     

正电子发射体层成像/计算机断层扫描在口腔颌面部肿瘤颈部淋巴结转移中的诊断价值

目的评价正电子发射体层成像/计算机断层扫描（PET/CT）在口腔颌面部肿瘤颈部淋巴结转移诊断中的价值。方法检索中国生物医学文献数据库、Medline（OVID）和EMBASE（检索时间为2010年12月13日）,并采用手工检索19种中文口腔医学期刊的方法收集PET/CT对口腔颌面部肿瘤颈部淋巴结转移的诊断性试验。由2名研究者分别进行文献纳入及文献质量评价,应用MetaDisc 1.4进行Meta分析。结果共9篇文献符合纳入标准。Meta分析结果显示PET/CT对口腔颌面部肿瘤颈部淋巴结转移（以淋巴结分区为单位）的合并敏感度、合并特异度分别为0.84、0.93;诊断比值比为47.89;工作曲线下面积为0.973 8。结论PET/CT对口腔颌面部肿瘤颈部淋巴结转移的诊断准确性很高,可以作为诊断口腔颌面部肿瘤颈部淋巴结转移的选择,但在选择时应该充分考虑其诊断费用和安全性。     

MRI诊断口腔鳞癌颈淋巴结转移的临床研究

目的研究磁共振成像（MRI）用于诊断口腔鳞癌病例是否存在颈淋巴转移的应用价值。方法选用中山大学附属第一医院口腔颌面外科2000～2005年首诊收治并经病理检查证实的口腔鳞癌病例48例，术前均行颈部淋巴结MRI检查及临床触诊检查。对照术后病理结果，计算MR／检查及临床触诊检查对颈部转移淋巴结检出的敏感率、特异率及准确率等。对两种方法进行比较。结果术前MRI对本组口腔鳞癌病例颈部淋巴结转移情况检查的敏感率、特异率及准确率均高于临床触诊，对口腔鳞癌颈淋巴结转移的术前评估具有较高的诊断价值。     

超声造影对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值评价

目的 ：探讨超声造影（contrast-enhanced ultrasound,CEUS）对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值。方法：选择41例接受手术治疗并行颈淋巴清扫术的口腔颌面部鳞癌患者,术前均行常规超声及CEUS检查颈部淋巴结。按术后病理诊断结果分为转移组和非转移组,评价2组淋巴结常规超声和CEUS影像特征的差异,并采用多因素Logistic回归模型分析转移性淋巴结的相关危险因素。应用受试者工作特征（ROC）曲线评价2种检查对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值。数据采用SPSS 25.0软件包进行统计学分析。结果：病理检出17例患者共29个转移性淋巴结,24例患者共28个非转移性淋巴结。转移组常规超声表现为长短径之比（L/S）≤2、形态不规整、淋巴门结构异常、内部回声不均匀、周边型或混合型血流,与非转移组有统计学差异（P<0.05）。转移组与非转移组的灌注模式、灌注类型比较,差异有统计学意义（P<0.05）。常规超声表现为形态不规整、淋巴门结构异常、内部回声不均匀、周边型或混合型血流;CEUS表现为向心型或混合型、有不规则灌注缺损的不均匀增强型或微弱增强...     

口腔颌面癌瘤的颈淋巴结转移及颈淋巴清扫术的临床研究

目的 探讨口腔颌面癌瘤颈淋巴结转移的部分规律及其与颈淋巴清扫术间的关系。方法 对250例行颈淋巴清扫联合根治术的口腔颌面癌病例进行回顾性研究。结果 口腔颌面癌颈淋巴结转移率为18．8％，其中鳞癌的颈淋巴结转移率为23．4％，腺上皮源性癌颈淋巴结转移率为9．6％，颈淋巴结转移临床诊断与病理诊断符合率为58．4％，漏诊率为9．1％。结论 鳞状上皮细胞癌比腺上皮源性癌更易发生颈淋巴结转移；临床诊断阳性的颈淋巴结应实施颈淋巴清扫术，对N0期颈淋巴结应采取适时监测，当其转为阳性时可再行手术治疗。     

老年口腔鳞癌前哨淋巴结活检的临床病理研究

目的:探讨前哨淋巴结活检(sentinel lymph node biopsy,SLNB)预测老年口腔鳞癌患者颈部淋巴结转移的价值及提高病理准确性的方法。方法:对18例临床及影像学检查阴性的老年口腔鳞癌患者,采用1%美兰示踪定位识别前哨淋巴结,随后行全颈淋巴结清扫,将SLN做连续病理切片检查。结果:18例患者中检出SLN14例,其中13例的SLN能准确预测颈部淋巴结的转移状况。结论:应用美兰能准确定位SLN,前哨淋巴结连续病理切片活检结果,能准确预测颈部淋巴结的转移状况,具有潜在的临床应用价值。     

Histological distribution of cervical lymph node metastases from intraoral/oropharyngeal squamous cell carcinomas.

The histological frequency and distribution of cervical lymph node metastases was studied in 326 neck dissections from 253 patients with an intraoral/oropharyngeal squamous cell carcinoma. Metastasis was evident in 118 patients (47%) and 18 had bilateral metastasis. For primary sites other than the tongue, metastasis developed initially in a node(s) in the first drainage group (level I or II) with progressive involvement of neighbouring nodes ('overflow'). Simultaneous bilateral metastases were seen in some tumours of the floor of mouth, tongue and oropharynx which involved the midline. An erratic distribution of metastases suggestive of 'fast-tracking' (skip lesions and peppering) was only seen in tongue tumours. The pattern of metastatic spread indicates that level IV nodes must be included in staging and therapeutic neck dissections in tongue cancer. Metastasis to 'accessory' lymph nodes (lingual, buccal) occurs infrequently but may explain some 'local' recurrences.     

Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma

We prospectively studied 49 patients with oral squamous cell carcinoma (SCC) who had their cervical regional lymph nodes examined by ultrasound (US), with or without fine needle aspiration cytology (FNAC), for the detection of metastatic spread. They were screened over a two-year period (1993-1995) by computed tomography (CT) and magnetic resonance imaging (MRI) or both to measure the primary tumour. US, with or without FNAC, was used to stage the neck. All tumours were biopsied preoperatively and the diagnosis of SCC conformed by histological examination. Management of the neck was based on US staging. Thirty-five patients had neck dissections and 14 were managed conservatively. Mean follow-up was 30 months (range 24-48). All patients were alive at one year, but one died at 14 months from recurrence of disease in the neck. There were 3 false negatives (6%). We find that US, with or without FNAC, is an accurate (86%), sensitive (92%) and specific (83%) technique for the preoperative assessment of lymph node metastases in patients with SCC.     

Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI

BACKGROUND: The choice of treatment in patients with oral malignancies depends on accurate pretreatment staging and particularly the detection of lymph node involvement. Therefore staging of the neck should be as accurate as possible. PATIENTS: One hundred and six patients with histologically proven squamous cell carcinoma of the oral cavity. STUDY DESIGN: In a prospective study, PET using fluoro-desoxy-glucose (18F-FDG), ultrasound, CT and MRI of head and neck were compared with the postoperative histologic tissue evaluation. Two thousand one hundred and ninety-six neck lymph nodes of 106 patients were investigated. In all patients the tumour was resected and a lymph node dissection was performed. Results: The diagnostic procedures showed the following results when compared with the histological findings: PET: sensitivity 70%, specificity 82%, accuracy 75%; Ultrasound: 84%, 68%, 76%; CT: 66%, 74%, 70%; MRI: 64%, 69% 66%. Thus PET showed the highest specificity while ultrasound had the highest sensitivity compared with the other staging procedures. A nonsignificant correlation was found between the size of a lymph node metastasis and the ability to detect it. In 10 patients, second primary tumours or distant metastases were detected by PET only. CONCLUSION: Due to the high number of small lymph node metastases from oral cavity carcinoma, the non-invasive neck staging methods are limited to a maximum accuracy of 76%. Elective neck treatment should be mandatory for all patients with squamous cell carcinoma of the oral cavity.     

头颈部非霍厅金淋巴瘤的CT表现

目的 评价头颈部非霍奇金淋巴瘤（ｎｏｎ－Ｈｏｄｇｋｉｎ ｌｙｍｐｈｏｍａ,ＮＨＬ）的ＣＴ表现特点,为临床诊疗提供可靠依据。方法 将３６例ＮＨＬ病灶分为颈淋巴结内线和淋巴结外组,并观察其ＣＴ形态、密度和边缘。结果 结外ＨＮＬ病 变共３９灶（３１例）,依次风于Ｗａｌｄｅｙｅｒ环（１１灶）、上颌８灶）、颌面间隙（７灶）、肋腺（６灶）和头颈其他部（７灶）。病变形态有肿块和粘膜异常增厚之分。结内ＮＨＬ病变共     

Neck dissection: nomenclature, classification, and technique

Lymph node status is the single most important prognostic factor in head and neck cancer because lymph node involvement decreases overall survival by 50%. Appropriate management of the regional lymphatics, therefore, plays a central role in the treatment of the head and neck cancer patients. Performing an appropriate neck dissection results in minimal morbidity to the patient, provides invaluable data to accurately stage the patient, and guides the need for further therapy. The purposes of this article are to present the history and evolution of neck dissections, including an update on the current state of nomenclature and current neck dissection classification, describe the technique of the most common neck dissection applicable to oral cavity cancers, and discuss some of the complications associated with neck dissection. Finally, a brief review of sentinel lymph node biopsy will be presented.     

头颈部非霍奇金淋巴瘤的CT表现

目的　评价头颈部非霍奇金淋巴瘤(nonHodgkinlymphoma,NHL)的CT表现特点,为临床诊疗提供可靠依据。方法　将36例NHL病灶分为颈淋巴结内组和淋巴结外组,并观察其CT形态、密度和边缘。结果　结外NHL病变共39灶(31例),依次见于Waldeyer环(11灶)、上颌(8灶)、颌面间隙(7灶)、腮腺(6灶)和头颈其他部(7灶)。病变形态有肿块和粘膜异常增厚之分。结内NHL病变共累及16侧颈区淋巴结。结外NHL伴结内NHL者共10侧颈区。结论　头颈部结外NHL的CT表现特点为多发边缘不光滑的软组织实性肿块;颈淋巴结内NHL多有坏死和边缘增强,淋巴结融合肿块则于单发结内NHL中多见     

Routine removal of the carotid sheath as part of neck dissection is unnecessary if grossly uninvolved as seen intra-operatively

The aim of this research was to determine the pathologic invasion of the carotid sheath (CS) when found grossly uninvolved during surgery, in patients undergoing neck dissection for head and neck squamous cell carcinoma (HNSCC). A prospective study was undertaken in 70 consecutive patients with biopsy proven HNSCC, without prior history of any treatment, undergoing neck dissection, in whom the CS was found grossly uninvolved intra-operatively, were included. A total of 80 neck dissections were performed. Supra-omohyoid neck dissections for clinically N0 neck and appropriate modified radical neck dissections for clinically N+ neck were carried out. 129 CS were dissected separately and thoroughly examined by well trained head and neck pathologists for tumour infiltration and the presence of lymphatic tissue. On microscopic examination, 27 patients were N0 status and the remaining 43 (61.4%) had at least one metastatic lymph node (N+). None of 129 CS specimens show the presence of normal lymphatic tissue or metastatic tumour deposits. The authors think that avoiding resection of the CS in the absence of gross invasion by nodal disease is possible without jeopardising oncologic safety. A preserved CS might offer protection to the important neurovascular structures and reduce significant morbidity.     

cN0头颈鳞癌哨位淋巴结示踪法的研究进展

颈部哨位淋巴结是头颈部鳞癌最早发生转移的淋巴结,其所在位置及有无转移或微转移,是决定是否行区域性颈淋巴清扫的一个重要指标。对于哨位淋巴结阴性的cN0患者,为减少过度治疗,精确定位哨位淋巴结十分重要。目前多采用示踪法检测哨位淋巴结,本文就其判断cN0头颈鳞癌隐匿性转移的研究进展作一综述。     

Preoperative computed tomography for determining nodal status combined with histologic grading as a prognostic factor for patients with tongue carcinoma

Objectives To evaluate the predictive value of preoperative neck computed tomography (CT) in combination with histologic grading as a prognostic factor for patients with tongue carcinoma. Methods Fifty-five patients with squamous cell carcinoma of the tongue were examined by CT prior to radical neck dissection. The locoregional failure and survival rates of these patients were analyzed in relation to their clinical characteristics, histologic grading (World Health Organization, WHO) based on tongue biopsy, and imaging diagnoses prior to surgery. Results Logistic multivariate regression analysis showed that both histologic grading and number of metastic lymph nodes on CT were significant and independent prognostic factors in locoregional failure (p=0.009 and p=0.009, respectively). When the number of metastatic lymph nodes detected on preoperative neck CT were combined with the histologic grading for the evaluation, the five-year overall survival rates of A group (0 node with any Grade, or 1 node with GradeI–II) and B group (1 node with GradeIII, or 2 or more nodes with any Grade) were 74.5% and 37.5%, respectively (p=0.001). The difference was more significant than histologic grading alone or the number of metastatic lymph nodes seen on CT alone. Conclusions The combination of preoperative neck CT with histologic grading of the primary tumor is useful as a prognostic indicator for patients with tongue carcinoma.