口腔疾病防治 ›› 2020, Vol. 28 ›› Issue (5): 336-340.DOI: 10.12016/j.issn.2096-1456.2020.05.013

• 综述 • 上一篇    

早期舌鳞癌颈淋巴转移的规律及评估因素研究进展

张海峰1,南欣荣2(),华永晴1   

  1. 1. 山西医科大学口腔医学院· 口腔医院,山西 太原(030001);
    2. 山西医科大学第一医院口腔颌面外科,山西 太原(030001
  • 收稿日期:2019-01-04 修回日期:2020-02-14 出版日期:2020-05-20 发布日期:2020-04-24
  • 通讯作者: 南欣荣
  • 作者简介:张海峰,硕士,Email: 365873054@qq.com
  • 基金资助:
    山西省重点研发计划项目(201803D31094)

Research progress on the consistency and evaluation factors of cervical lymphatic metastasis in early tongue cancer

ZHANG Haifeng1,NAN Xinrong2(),HUA Yongqing1   

  1. 1. Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
    2. First Hospital of Shanxi Medical University of Oral and Maxillofacial Surgery, Taiyuan 030001, China.
  • Received:2019-01-04 Revised:2020-02-14 Online:2020-05-20 Published:2020-04-24
  • Contact: Xinrong NAN

摘要:

早期舌鳞癌易发生隐匿性淋巴转移,因此早期舌鳞癌是否进行颈淋巴清扫一直是众多学者争议的问题。为了准确评估患者颈部情况,确定是否同期进行颈淋巴清扫,本文就性别、年龄、原发灶部位、术前辅助检查、浸润深度、病理分级、神经以及血管淋巴管浸润等评估因素进行综述。文献复习结果表明,早期舌鳞癌颈淋巴主要回流至Ⅰ、Ⅱ、Ⅲ区,跳跃性转移较为罕见,早期舌鳞癌的颈淋巴转移主要受浸润深度、病理分级、神经浸润、血管淋巴管浸润等因素影响,为了使早期舌鳞癌患者获得较高的生存率,对于术前通过超声或磁共振成像(magnetic resonance imaging,MRI)显示肿瘤浸润深度超过5 mm、病理分级高、已经存在麻木或者疼痛等临床症状的患者以及在冰冻结果中已存在神经、血管淋巴管浸润的T1期和T2期患者,应考虑切除原发灶同时行选择性颈淋巴清扫。

关键词: 舌, 癌, 鳞状细胞癌, 肿瘤分期, T1期, T2期, 颈淋巴转移, 浸润深度, 神经侵犯, 血管淋巴管浸润, 评估因素, 颈淋巴清扫

Abstract:

Early tongue cancer is more prone to occult lymphatic metastasis than other oral cancers. Therefore, the decision of whether to perform neck dissection in the early stage of tongue cancer has been a controversial issue among many scholars. To accurately evaluate the neck condition of patients and determine whether neck dissection should be performed, this article reviews evaluation factors such as sex, age, tumor site, preoperative auxiliary examination results, depth of invasion, pathological grade, and nerve, lymphatic and vascular invasion. A literature review showed that the cervical lymphatics of early tongue cancer mainly migrated to regionsⅠ,Ⅱ and Ⅲ, and distant metastasis was rare. The cervical lymphatics of early tongue cancer were mainly affected by the depth of invasion, pathological grade, and nerve, lymphatic and vascular invasion. To achieve a high survival rate for patients with early tongue cancer, patients with preoperative ultrasound or MRI showing a tumor invasion depth of more than 5 mm, a tumor with a higher pathological grade, and clinical symptoms such as numbness or pain who are in stage T1 and T2 and who have already have nerve and vascular lymphatic infiltration according to the frozen sectioning results should be considered for primary simultaneous cervical lymphatic dissection.

Key words: tongue, cancer, squamous cell carcinoma, tumor stage, stage T1, stage T2, cervical lymphatic metastasis, depth of invasion, perineural invasion, lymphatic and vascular invasion, evaluation factors, neck dissection

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