颊黏膜鳞癌颈淋巴结转移规律与颈淋巴清扫的研究.docVIP

颊黏膜鳞癌颈淋巴结转移规律与颈淋巴清扫的研究 【摘要】 　　［目的］ 探讨颊黏膜鳞癌的颈淋巴结转移分布规律和颈淋巴清扫的关系。［方法］ 对浙江省肿瘤医院头颈外科1990年1月~2004年12月行颈淋巴清扫的52例颊黏膜鳞癌进行回顾性分析。［结果］ 颊黏膜鳞癌颈淋巴结转移率为26.9%（14/52），各区淋巴结转移率Ⅰ区为40.6%，Ⅱ区34.4%，Ⅲ区25.0%，Ⅳ区0。分期中T1 与T2 及T3 与T4之间颈淋巴结转移率无显著差异(Pgt;0.05), 但 T1 、T2 与T3 、T4 之间随分期增高而颈淋巴结转移率明显增加(Plt;0.01)。颊黏膜鳞癌随分化程度的变差，区域淋巴结转移率增加。［结论］ 对于颊黏膜鳞癌，可以择区清扫Ⅰ、Ⅱ、Ⅲ区淋巴结，Ⅳ区清扫一般仅适合于病理类型为低分化癌者；T3 、T4的需要行胸大肌等皮瓣修复的患者；临床淋巴结转移为N2的患者。 【关键词】 颊　口腔黏膜　口腔肿瘤　肿瘤　鳞状细胞　淋巴转移　颈淋巴结清扫术 　　A Study of Cervical Lymph Nodes Metastatic Rule and Neck Dissection in Patients with Buccal Squamous Cell Carcinoma Abstract： ［Purpose］ To investigate the relationship between the distribution of metastatic lymph node and neck dissection in patients with buccal squamous cell carcinoma. ［Methods］ Fiftytwo patients with buccal squamous cell carcinoma undergoing neck dissection in Zhejiang Cancer Hospital from January 1990 to December 2004 were reviewed retrospectively.［Results］ The lymph node metastatic rate was 26.9% in buccal squamous cell carcinoma, and the rates of different levels were as follows: levelⅠ, 40.6%; levelⅡ, 34.4%;level Ⅲ, 25.0%; and level Ⅳ, 0. The lymph node metastatic rate was not significantly different between T1 and T2, and between T3 and T4 (Pgt;0.05), but the rate was higher in T3+T4 group than that in T1+T2 group (Plt;0.01). The lymph node metastatic rate increased with decreasing of differentiation.［Conclusion］ Ⅰ,Ⅱand Ⅲ level lymph node should be dissected in buccal cancer patients, and the level Ⅳ node dissection is suitable for low differentiation cancer; stage T3 or T4with flaps reconstruction and N2 node metastasis. Key words: cheek; mouth mucosa; mouth neoplasms; neoplasms, squamous cell; lymphatic metastasis; radical neck dissection 口腔鳞癌是头颈部最常见的恶性肿瘤,影响其预后因素较多,而淋巴结转移是重要因素之一,只要有同侧或对侧单个淋巴结发生转移,生存率即降低50％，若出现对侧或双侧颈淋巴结转移，则其预后再进一步降低50%[1]。而颊黏膜癌作为口腔癌的重要组成部分，了解其颈淋巴结的转移规律和处理极其重要。本文就本科52例颊黏膜鳞癌患者的颈淋巴结外科处理的资料进行回顾性分析，探讨其颈淋巴结的转移规律并进一步分析其处理方法，以供临床设计手术方案提供参考。 1 材料与方法 浙江省肿瘤医院头颈外科