【摘要】 目的 ：探讨晚期口腔鳞状细胞癌（advanced oral squamous cell carcinoma, AOSCC）患者颈淋巴清扫术中是否保留胸锁乳突肌（sternocleidomastoid muscle, SCM）对预后的影响。方法：收集2013年1月至2017年6月广西医科大学附属口腔医院口腔颌面外科诊治的235例晚期（临床Ⅲ期和Ⅳ期）口腔鳞状细胞癌且接受颈淋巴清扫术患者的资料信息并进行回访，比较保留与切除SCM的两种不同颈淋巴清扫术式之间总生存期（OS）、局部无复发生存期（LRFS）以及颈部无复发生存期（RRFS）的差异。采用SPSS 25.0软件包对数据进行统计学分析。结果：235例患者中，101例术中保留SCM,134例切除SCM,2组5年生存率和5年颈部复发率无统计学差异。Kaplan-Meier法单因素分析结果显示，2组的OS、LRFS和RRFS之间均无统计学差异。Cox多因素回归分析进一步校正结果显示，是否切除SCM均不是OS、LRFS和RRFS的独立影响因素，N分期和术后放化疗是AOSCC患者OS、LRFS和RRFS的独立影响因素。结论：AOSCC患者颈部手术行保留SCM的颈淋巴清扫术对生存和复发（包括局部复发和颈部复发）均无影响，对转移淋巴结未侵犯SCM的AOSCC患者行保留SCM的颈淋巴清扫术是可行的；N分期和术后是否放化疗影响AOSCC的预后。更多还原

【Abstract】 PURPOSE: To investigate the prognosis of advanced oral squamous cell carcinoma(AOSCC) patients undergoing neck dissection with sternocleidomastoid muscle(SCM) preservation and resection. METHODS: From January 2013to June 2017, a total of 235 AOSCC patients(stage Ⅲ and stage Ⅳ) who were diagnosed and underwent neck dissection at the Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Guangxi Medical University, were collected and followed-up. The differences in overall survival(OS), local recurrence-free survival(LRFS) and regional recurrence-free survival(RRFS) were compared between different surgical procedures. SPSS 25.0 software package was used for statistical analysis. RESULTS: Among 235 patients with postoperative follow-up, 101 patients retained the SCM during operation, and 134 patients had SCM removed. There was no significant difference in 5-year survival rate and 5-year regional recurrence rate between the SCM preservation group and the SCM resection group. Kaplan-Meier method of univariate analysis showed that SCM preservation or resection had no significant difference in OS, LRFS and RRFS. Cox multivariate regression analysis results showed that there was no significant difference between different surgical procedures in OS, LRFS and RRFS, while N stage and postoperative chemoradiotherapy were independent influencing factors for OS,LRFS and RRFS in AOSCC patients. CONCLUSIONS: Neck dissection with SCM preservation in AOSCC patients has no effect on survival and recurrence(including local recurrence and regional recurrence). It is feasible for AOSCC patients to undergo SCM-preserving neck dissection when metastatic cervical lymph nodes do not invade SCM. N stage and postoperative chemoradiotherapy affect the prognosis of AOSCC patients.更多还原