【摘要】 目的　探讨舌体鳞癌cN0 患者的颈部处理。方法　舌体鳞状细胞癌共 1 85例 ,男性 1 0 2例 ,女性 83例 ,年龄 2 8～ 88岁。所有病例均行原发灶手术切除 +颈淋巴清扫术。原发灶及颈淋巴结全部术后病理证实。结果　Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者颈淋巴结转移率分别为 1 6 66 %和 38 0 5 % ;1 4 8例cN0 患者鳞癌Ⅰ级和Ⅱ级颈淋巴结转移率分别为 1 7 42 %和 37 50 % ;原发灶侵及粘膜下层、肌层和神经者 ,其颈淋巴结转移率分别为 9 0 0 %、31 37%和 55 55 %。 1 85例患者 5年生存率为 72 43 % ,其中颈淋巴有转移和无转移者 5年生存率分别为 44 44%、83 96 %。 1 4 8例cN0 患者颈淋巴结阳性者 2 9例 ,其转移区 :下颌下 +颏下 (Ⅰ )占 2 2 64 % ,颈深上 (Ⅱ )占 35 84% ,颈深中 (Ⅲ )占 2 6 40 % ,颈深下(Ⅳ )为 1 5 0 9% ,颈后 (Ⅴ )为 0 %。选择性颈淋巴清扫术 5年生存率为 85 1 3 % ,治疗性为 2 1 62 %(χ2 =2 9 73 ,P <0 0 1 )。选择性颈淋巴清扫术病例中 ,有淋巴结转移 5年生存率为 68 96 % ,未见淋巴结转移者 5年生存率为 89 0 7%。选择性颈淋巴清扫术有淋巴结转移 5年生存率为 68 96 % ,而治疗性有淋巴结转移 5年生存率仅 2 0 0 % (P <0 0 1 )。结论　①cN0 患者除早期 (Ⅰ期 )可行颈部观察 ,Ⅱ～Ⅳ期须?更多还原

【Abstract】 Objective To disscuss the treatment of cN 0 tongue carcinoma patients. Methods 185 cases of the mobile tongue carcinoma patients (male 102, female 83, aged 28 to 88) treated with surgery from 1988 5 to 1995 6 had been followed up and retrospectively anslysed. Extensive resection of the primary tumors and neck dissections were performed, and all the samples were pathological positive. Results The cervical lymphatic node metastasis rates for stage Ⅰ Ⅱ, Ⅲ Ⅳ disease, grade Ⅰ, Ⅱ disease were 16 66%, 38 05%, 17 42% and 37 50% respectively. And the rates were 9 00%, 31 37% and 55 55% for submucous infiltration, muscle infiltration and perineural infiltration, respectively. The overall 5 year survival was 72 43%, and the 5 year specific survival rate was 44 44% and 83 96% for those having or not having cervical node metastasis. The levels of 29 patients with positive node metastasis for 148 cN 0 patients were submandibular and submental lymphatic nodes (22 64%), supeior deep cervical lymphatic nodes (35 84%), middle deep cervical lymphatic nodes(26 41%),inferior deep cervical lymphatic nodes (15 09%), posterior neck lymphatic nodes(0.00%).The over all 5 year survival rates for selective neck dissection were 85 13%and 21 62%in therapeutic dissection (χ 2=29 73, P < 0 01). Patients performed selective neck dissection the rates were 68 96% and 89 07%respectivelywith or without lymphatic node metastasis.Comparably the 5 year rate was only 20 00% for the patients performed the therapentic dissection with lymphatic node metastasis. Conclusions (1)cN 0 patients should be observed carefully in stage Ⅰ,and the selective dissectionmust be performed in stage Ⅱ Ⅳ. (2) Supraomohyoid ND is essential for T 2 patients, and functional ND is essential for T 3 4 patients. (3) There is correlation between cervical metastasis and the stage, grade or infiltration of tongue cancer ( P < 0 05). The prognosis could be expected from these factors.更多还原