择区性颈清扫术在临床N0舌鳞状细胞癌治疗中的应用

目的比较择区性颈清扫术(selective neck dissection，SND)与经典性或改良性颈清扫术(radical neck dissection，RND)在治疗舌鳞状细胞癌颈淋巴结临床阴性(cN0)患者中的效果。方法将1998年1月-2002年12月之间采用肩胛舌骨肌上颈清扫术(Ⅰ～Ⅲ区)14例及Ⅰ～Ⅳ区清扫19例(SND组)共33例与1980年1月-1997年12月之间112例采用经典性或改良性颈清扫术(RND组)的病例，根据T分期、综合治疗方式和淋巴结病理情况进行随机配对分析。Kaplan—Meier方法计算复发率和颈部淋巴结复发或生存趋势。结果RND组5年颈部复发率为9．1％(3例)，SND组5年同侧颈部复发率12．1％(4例)；两组的5年生存率分别是78．8％和82．9％(分别为26例和28例)。Ⅰ-Ⅲ区清扫组5年颈部复发率为21．2％(3例)，清扫野外复发率为14．3％(2例)；Ⅰ-Ⅳ区清扫组5年同侧颈部复发率5．3％(1例)，清扫野外复发率为0。结论与经典性或改良性颈清扫术相比，择区性颈清扫术并不影响cN0舌癌患者的肿瘤治疗效果，术式以Ⅰ～Ⅳ区清扫为适宜。

Selective neck dissection in the management of tongue squamous cell carcinoma with clinically negative nodes

OBJECTIVE: To compare the effectiveness of selective neck dissection (SND) with radical or modified radical neck dissection (RND) for the management of tongue squamous cell carcinoma with clinically negative nodes (cN0). METHODS: There were 33 patients who were treated with SND (including 14 supraomohyoid neck dissection and 19 level I -IV neck dissection ) between January 1998 and December 2002. According to T classifications, treatment modality and pathological status of lymph node (pN), the control group of 33 patients were randomly selected from the cN0 tongue squamous cell carcinoma patients who were treated with RND between January of 1980 and December of 1997. Kaplan-Meier was used to calculate the rate of regional recurence and 5-year survival rate. RESULTS: The neck recurrent for RND population was 9.1% (3 patients), which was not statistically different from the neck recurrent in the SND population 12.1% (4 patients). Also, the 5-year survival rates were no statistic difference between SND and RND groups (82.9%, 28 patients vs 78.8%, 26 patients). The rate of recurrent outside the dissection area for level I -IV neck dissection population was 0, which was statistically different from the rate of recurrent outside the dissection area in the supraomohyoid neck dissection population (14.3%, 2 patients). CONCLUSIONS: Comparing to the radical or modified neck dissection, the SND offered the same oncologic compromise for patients with cN0 tongue squamous cell carcinoma. I -IV neck dissection was recommended.