下颌下三角清扫的基础及临床研究：探讨早期口腔癌颈清扫中保留同侧下颌下腺的可行性-basic and clinical study of mandibular triangle dissection to explore the feasibility of preserving the same submandibular gland during neck dissection for early oral cancer.docxVIP

目录中文摘要……………………………………………………………1英文摘要……………………………………………………………2前言…………………………………………………………………4资料与方法…………………………………………………………6结果…………………………………………………………………10讨论…………………………………………………………………17结论…………………………………………………………………23参考文献……………………………………………………………24致谢…………………………………………………………………27综述…………………………………………………………………29参考文献……………………………………………………………37下颌下三角清扫的基础及临床研究：探讨早期口腔癌颈清扫中保留同侧下颌下腺的可行性中文摘要目的研究口腔癌转移到下颌下腺的发生率，以及下颌下腺中淋巴结的发生率，从而探索在早期口腔癌颈清扫病例中保留同侧下颌下腺可行性的理论基础及临床依据。方法通过对89侧颈清扫病例的标本解剖、组织学及影像学检查，对下颌下腺的连续切片及HE染色，研究下颌下腺内有无淋巴结，研究下颌下三角淋巴结的分布规律及淋巴结转移情况，并研究MRI对口腔癌颈部淋巴结转移的检出率，结合术后病理报告加以证实。结果下颌下腺内未发现有肿瘤转移，亦未发现腺内淋巴结。我科所行颈清扫病例以口腔鳞状细胞癌为主，占93.6%（73/78例）。下颌下淋巴结数目多为4个；从分布区域看，面前静脉旁淋巴结构成比最高，占95.5%(85/89侧)，转移率也最高，占13.5%(12/89侧)。89侧颈清扫术后病理报告颈部淋巴结转移率为44.9%（40/89侧），MRI对口腔癌颈部淋巴结转移的检出率为40%（16/40侧），MRI对颈部淋巴结的诊断与病理报告的的符合率为51.7%（(30+16)/89侧）。结论本研究未发现下颌下腺内有肿瘤转移，亦未发现腺内淋巴结，结合文献，口腔癌转移到下颌下腺极为罕见，只有在口腔癌原发灶直接侵犯下颌下腺时才出现腺内转移性肿瘤细胞浸润。故推论颈清扫中保留同侧下颌下腺具有可行性，除非患者下颌下腺曾行手术或放射治疗，或者腺体与原发肿瘤密切相关，但这对手术技巧要求更高，要注意保存下颌下腺的功能，并清扫干净下颌下腺周围的淋巴结。关键词下颌下腺淋巴结转移组织病理学口腔干燥症1BasicandClinicalResearchofDissectionofSubmandibularTriangle:InvestigatingtheFeasibilityofIpsilateralSubmandibularGlandPreservationDuringNeckDissectioninPatientsWithEarly-StageOralCancerAbstractObjectiveTostudytheincidenceoforalcarcinomametastasistothesubmandibulargland,aswellastheincidenceoflymphnodesinsidethesubmandibulargland,forinvestigatingthefeasibilityofipsilateralsubmandibularglandpreservationduringneckdissectioninpatientswithearly-stageoralcancer.Methods78patientsundergoing89neckdissectionswerestudiedbydissection,histologicalexaminationandimagingexamination.Allsubmandibularglandspecimenswerecontinuouslysectionedandobservedhistologicallyafterhematoxylinandeosinstaining.Tofindoutwhethertherearelymphnodesinsidethesubmandibulargland,tostudythedistributionandmetastasisofsubmandibularlymphnodes,andtostudythecontributionofMRIinshowingthemetastasisfromoralcarcinomatocervicallymphnodes.Allofthesewereconfirmedbypathologicalreportsafteroperation.ResultsTherewereneithermetastaticneoplasmnorlymphnodesf