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。

Management of the floor of mouth in tongue cancer patients: A clinical study of rational surgical pattern

PURPOSE: In order to prevent the recurrence and metastasis of carcinoma of the tongue and enhance the survival for oral cavity cancers,a modified neck dissection with resection of the floor of mouth was proposed and discussed. METHODS: A modified neck dissection was performed in 20 patients.The mandible was spilt and swung,and the intermediate tissue of the floor of mouth was resected, to assure en bloc excision of the tumor. Other 20 patients who had tongue cancer and underwent RND were selected as control. RESULTS: In the experimental group, no recurrence occurred and contralateral lymph node metastasis was seen in 2 cases. The metastasis rate was 10%. In the control group, recurrence occurred in 7 cases and contralateral metastasis was seen in 5 cases. The recurrent and metastatic rate was 60%. The metastatic or recurrent rate of patients treated with the modified neck dissection was significantly lower than that of patients treated with traditional method, P<0.05. CONCLUSION: This finding offers evidence that traditional discontinuous neck dissection may not address all lymph nodes at risk in the treatment of oral cavity cancer. We strongly suggest that neck dissection with resection of floor of mouth should be performed rather than traditional discontinuous neck dissection.