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目的探讨口腔黏膜鳞状细胞癌颈Ⅱ区连续整块切除的意义。方法选取安徽医科大学附属省立医院口腔医学中心颌面头颈外科1999年1月至2004年1月期间行颈清扫术且病例记录及术后随访资料完整的117例病例,以颈Ⅱ区连续整块切除与否为指标,观察根治性颈清扫术(RND)和功能性颈清扫术(FND)两种术式的术后颈部淋巴结复发率。结果117例病例中,术后病理诊断为淋巴结转移癌32例,转移率为27.35%(32/117),其中RND26例,FND6例。经3年期随访,颈清扫术后淋巴结复发18例,复发率为15.38%,其中RND12例,FND6例。位于Ⅱ区淋巴结复发有15例,占83.33%,其中RND9例,FND6例。结论对FND应有严格的指征,确定癌肿病例的生存质量必定建立于肿瘤控制的基础上,得出肿瘤不能根治则谈不上生存质量的结论,建议提倡施行保留胸锁乳突肌(必要时加副神经)的FND术式。
Objective To investigate the significance of continuous lump resection of cervical Ⅱ region in oral squamous cell carcinoma. Methods A total of 117 cases with complete neck and neck dissection during the period from January 1999 to January 2004 were selected from the Department of Oral and Maxillofacial Surgery, Provincial Hospital Affiliated to Anhui Medical University. The resection or not was used as an index to observe the postoperative neck lymph node recurrence rate after radical neck dissection (RND) and functional neck dissection (FND). Results Of the 117 cases, 32 cases were diagnosed as lymph node metastasis with a metastasis rate of 27.35% (32/117), of which 26 cases were RND and 6 cases were FND. After 3-year follow-up, there were 18 cases of lymph node recurrence after neck dissection, the recurrence rate was 15.38%. There were 12 cases of RND and 6 cases of FND. There were 15 cases of lymph node recurrence in region Ⅱ, accounting for 83.33%, including 9 cases of RND and 6 cases of FND. Conclusions There should be strict indications for FND. The quality of life of cancer cases must be established on the basis of tumor control. It is concluded that the tumor can not be cured without quality of life. It is recommended to promote the implementation of the preservation of sternocleidomastoid muscle If necessary, plus nerve) FND surgery.