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目的 比较择区性颈清扫术(selectiveneckdissection,SND)与经典性或改良性颈清扫术(radicalneckdissection,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(清扫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。
Objective To compare the efficacy of selective necked dissection (SND) with classical or modified neck dissection (RND) in the treatment of patients with tongue squamous cell carcinoma of the cervical lymph node (cN0). Methods Between January 1998 and December 2002, 14 cases of scapular hyoid muscle neck dissection (Ⅰ ~ Ⅲ) and 19 cases of SND (Ⅰ ~ Ⅳ) One hundred and twelve cases with classical or modified neck dissection (RND group) between January and December 1997 were randomly paired according to T staging, comprehensive treatment and lymph node pathology. Kaplan Meier method to calculate the recurrence rate and neck lymph node recurrence or survival trend. Results The 5-year neck recurrence rate was 9.1% (3 cases) in RND group and 5% ipsilateral neck recurrence rate was 12.1% (4 cases) in SND group. The 5-year survival rates were 78.8% And 82.9% (26 cases and 28 cases respectively). The recurrence rates of neck in the groupⅠ ~ Ⅲ were 21.2% (3 cases) in 5 years, and the recurrence rate in the field was 14.3% (2 cases). The recurrence rates of ipsilateral neck in group Ⅰ ~ Ⅳ 5.3% (1 case), the recovery rate was 0 in the field. Conclusions Compared with the classic or modified neck dissection, the selective neck dissection does not affect the tumor treatment effect in patients with cN0 tongue cancer. The surgical procedure is suitable for the dissection of stage Ⅰ-Ⅳ.