下颌牙龈鳞状细胞癌两种颈淋巴结清扫术疗效对比分析

目的：对比分析肩胛舌骨上颈淋巴清扫术（SOND）和功能性全颈淋巴清扫术（FND）对下颌牙龈鳞状细胞癌的疗效。方法选取72例下颌牙龈癌患者，其中采用SOND者30例（SOND组），采用FND者42例（FND组），依据国际抗癌联盟2002年分期标准及美国耳鼻咽喉头颈外科学会1991年制定公布的颈部淋巴结Level分区法以及华盛顿大学生存质量问卷，比较两组患者术后颈部复发率及生存质量。结果两组患者术后同期（术后1、2～3、4～5年）及术后5年复发率的差异均无统计学意义（均P＞0.05）。SOND组和FND组颈部淋巴结阴性患者复发率分别为8.69%、6.06%，颈部淋巴结阳性患者复发率分别为57.14%、66.66%，组间比较差异均无统计学意义（均P＞0.05）；两组患者中同期颈部淋巴结阳性与阴性复发率的差异均有统计学意义（均P＜0.05）。两组合计，临床Ⅱ期与Ⅲ期及Ⅲ期与Ⅳ期间的差异无统计学意义（均P＞0.05），而Ⅱ期与Ⅳ期间的差异有统计学意义（P＜0.05）。FND组疼痛、面容外形、活动能力、消遣娱乐评分及总分均明显低于SOND组，差异均有统计学意义（均P＜0.05）。结论与FND比较，SOND虽不能降低患者术后颈部复发率，但可以提高术后生存质量，若无证据表明肿瘤转移到LevelⅣ、Ⅴ区，可以将SOND作为牙龈鳞癌患者的首选颈淋巴结清扫术式。

Suprahyoid neck dissection versus functional neck dissection in mandibular gingival squamous cell carcinoma

Objective To compare the effects of suprahyoid neck dissection（SOND） with functional neck dissection （FND） in patients with mandibular gingival squamous cellcarcinoma. Methods Seventy two patients with mandibular gingival squa-mous cellcarcinoma were enrol ed in the study, including 30 patients underwent SOND and 42 patients underwent FND. Neck recurrence rates and quality of life were compared between two groups. Results There were no significant differences in overal recurrence rate at 1, 2~3, 4~5 and 5 years after operation between two groups （P＆gt;0.05） . The recurrence rates in patients with negative cervical lymph node for SOND and FND groups were 8.69%and 6.06%respectively;and those in patients with positive cervical lymph node for SOND and FND groups were 57.14%and 66.66%, respectively （P＆gt;0.05）. The differences of recurrence rate between the patients with positive and negative cervical lymph node, between clinical stage II, III and III, IV at the same time points were statistical y significant （P＆lt;0.05）. The total score of QOL, the scores of pain, face appearance, physical activities and entertainment in group FND were significantly lower than those in SOND group （P＆lt;0.05）. Conclusion Compared with FND, SOND does not decrease neck recurrence rate, but it can improve the quality of life for patients with mandibular gingival squa-mous cellcarcinoma.