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目的:为减少舌癌患者术后复发率及转移率,探讨口底区域淋巴组织清扫术的范围、术式及其临床意义。方法:收集随访2000年5月～12月本科舌癌手术患者20例(原发灶T2或T3,未明显侵犯口底,颈部N0)。同期舌-(颌)-颈联合根治术,术中于颏孔前断离并外展下颌骨,以利直视下彻底清扫同侧口底中间带淋巴组织,达到完整舌-(颌)-颈根治。同期调查我院和外院舌癌手术后患者20例(术中口底中间带淋巴组织保留或未彻底清扫)作为对照,比较两组患者复发率与颈部淋巴结转移率。结果:实验组局部无1例复发,对侧淋巴结转移2例(T3),转移率10%。对照组口底或下颌下复发7例,对侧颈淋巴转移5例,复发转移率60%。P<0.05,有统计学显著性差异。结论:传统非连续性颈清扫并不能清除所有可能受累的淋巴结。对T2以上的舌癌患者,宜在传统的颈清术式基础上,断离、外展下颌骨,行同侧口底中间带组织的彻底清扫。
Objective: To investigate the recurrence and metastasis rate of tongue cancer patients and to explore the range, operation and clinical significance of lymph node dissection in mouth area. Methods: Twenty patients with undergone tongue cancer surgery from May 2000 to December 2000 were included in this study. The primary tumors were T2 or T3, but the mouth and neck were not significantly affected. Tongue - (jaw) - neck surgery combined with radical mastectomy, surgery in the mental foramen before disconnection and outreach of the mandible, in order to facilitate the immediate cleaning of the ipsilateral bottom of the median lymphoid tissue, to complete tongue - (jaw) Neck cure. In the same period, 20 cases of patients with tongue cancer after operation in our hospital and outside the hospital (with or without left middle larynx cleaning) were compared as control to compare the recurrence rate and cervical lymph node metastasis rate in both groups. Results: In the experimental group, there was no recurrence in one case and two cases of contralateral lymph node metastasis (T3) in the experimental group. The metastasis rate was 10%. In the control group, there were 7 cases of oral or submandibular recurrence, 5 cases of contralateral cervical lymph node metastasis and 60% of recurrence and metastasis. P <0.05, there is a statistically significant difference. CONCLUSIONS: Conventional nonconsecutive neck dissection does not clear all possible lymph nodes. For T2 or more of tongue cancer patients, should be based on the traditional method of neck dissection, detachment, outreach of the mandible, line ipsilateral bottom of the middle of the tissue with a thorough cleaning.