口底鳞状细胞癌颈淋巴结转移规律及处理的探讨

背景与目的：口底癌颈淋巴结转移规律方面的研究较少,本研究探讨口底癌颈淋巴结转移的分布特点和合理的治疗方法。方法：回顾性分析经根治性治疗的79例口底鳞癌病例,比较其临床和病理阳性淋巴结分布差异;比较临床淋巴结阳性组经根治性颈清扫术,上半颈清扫术术后颈部的复发率和临床淋巴结阴性组经根治性颈清扫术,上半颈清扫术,颌下三角清扫术的复发率,及临床观察组颈部的复发率。结果：临床和病理阳性淋巴结分布都以Ⅱ区为主,分别占61.8%和40.0%。其次是Ⅰ区和/或Ⅲ区,而Ⅳ,Ⅴ,Ⅵ区则极少;临床淋巴结阳性组中根治性颈清扫术术后颈部的复发率低于上半颈清扫术者,但无统计学意义（X^2=3.403,P=0.065);临床颈淋巴结阴性组中上半颈清扫术,颌下三角清扫术,临床观察等方法处理的颈部复发率分别是11.1%(1/9),40.0%(2/5)和23.5%(4/17),组间差异无统计学意义（X^2=1.554,P=0.46)。结论：口底鳞癌颈淋巴结转移的分布主要在Ⅰ、Ⅱ、Ⅲ区;临床颈淋巴结阴性者宜进行Ⅰ、Ⅱ、Ⅲ区（上半颈）淋巴结清扫术。

Rule of lymph node metastasis in the cancer of mouth floor and its treatment

BACKGROUND & OBJECTIVE: There was little report on the rule of lymph node metastasis in the cancer of mouth floor. The aim of this study was to investigate the rule of lymph node metastasis and investigate the reasonable treatment. METHODS: A total of 79 cases with squamous carcinoma of mouth floor were included into this study retrospectively. The distributive difference of clinical and pathological positive lymph node was compared. The recurrent rate of the patients who were performed with radical neck dissection and supra-half-neck dissection in clinical positive lymph node group were compared with the recurrent rate of the patients who were preformed with radical neck dissection, supra-half-neck dissection, submandibular triangle dissection, and clinical observational group. RESULTS: Clinical and pathological positive lymph node was found mainly in II region (61.8% and 40.0%, respectively), secondly in I and/or III region, and rarely in IV, V, and VI region. In clinical positive lymph node group, the recurrent rate of the patients who performed with radical cervical neck dissection was lower than supra-half-neck dissection, but without statistical significance (chi 2 = 3.403, P = 0.065). In clinical cervical negative lymph node group, the recurrent rates of the patients performed with supra-half-neck, submandibular triangle dissection, and in clinical observational group were 11.1% (1/9), 40.0% (2/5), and 23.5% (4/17), without statistical significance (chi 2 = 1.554, P = 0.46). CONCLUSION: Lymph node metastasis of cancer of floor of mouth mainly distributes in I, II, III region; The patients with negative cervical lymph node should be performed lymph node dissection in I, II, III region (supra-half-neck).