口腔癌颈淋巴清扫术中保留颌下腺的可行性研究

发布时间：2018-04-18 02:08

本文选题：口腔癌 + 颌下腺　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]通过组织病理学分析颌下腺周围淋巴结及颌下腺腺内淋巴结的分布情况、颌下腺切除原因、口腔癌患者淋巴结转移规律和口腔癌患颈淋巴结清扫术中切除颌下腺及其导管的病理学特点。探讨口腔癌颈淋巴清扫术中保留颌下腺的可行性。[方法](1)选取2015年10月至2016年9月至昆明医科大学附属口腔医院颌面外科诊治切除颌下腺的137例患者,术中对其进行观察,分离淋巴结,并记录淋巴结所处解剖位置,术后通过组织学病理检测颌下腺内是否存在腺内淋巴结,病理学检查结果为最终颌下腺切除原因。(2)采用回顾性研究方法,对符合标准的82例口腔癌患者病理资料进行收集整理,统计病理学资料。统计学分析颌下腺病例特点及其影响因素,淋巴结转移规律,颌下腺肿瘤安全性。(3)前瞻性的对2016年2月至2017年4月至昆明医科大学附属口腔医院颌面外科诊治的54例口腔癌患者进行研究。术中分离颈部各区淋巴结、颌下腺、颌下腺导管并及时冰冻送检,术后通过病理学组织学检查,确定颌下腺及颌下腺导管,淋巴结的病理特点并分析其影响因素。[结果](1)颌下腺原发疾病是切除颌下腺的主要原因,颌下腺炎性病变及颌下腺导管结石是颌下腺原发疾病中切除颌下腺比例最高的疾病。(2)所有病例均未发现颌下腺腺内淋巴结,良恶性肿瘤颌下腺腺周淋巴结出现率及淋巴结的平均数不等,差异均具有统计学意义。(3)颈淋巴清扫术中切除颌下腺主要为正常颌下腺,占60. 4%;颌下腺伴有慢性炎症或有炎性细胞浸润,约占37. 6%;颌下腺呈增龄性改变者7例约占4. 7%。高年龄患者及原发灶直接和外界接触或破溃后与外界接触者颌下腺内炎性细胞浸润发生率较高。(4)颌下腺导管的病理组织学研究中有2例(3.6%)导管内有癌栓形成,但导管未受累及。[结论]口腔癌转移到颌下腺周围淋巴结相对常见,但转移到颌下腺内十分罕见。因此理论上在口腔癌淋巴清扫中保留颌下腺在组织病理学层面上具有肿瘤安全性。对于原发灶距离颌下腺较远的口腔癌可考虑保留颌下腺并行颌下腺移植术。术后放疗时对颌下腺加以保护。保留颌下腺后应进行至少2-3年的随访,若发现复发或转移者则需再次手术。但此类研究尚缺乏随机对照试验,保留颌下腺的证据尚显不足,应当谨慎选择。
[Abstract]:[objective] to analyze the distribution of lymph nodes around submandibular gland and submandibular gland by histopathology, and to analyze the reason of submandibular gland excision.Lymph node metastasis in patients with oral cancer and pathological features of submandibular glands and ducts in patients with oral cancer.To investigate the feasibility of preserving submandibular gland during cervical lymph node dissection for oral carcinoma.[methods] from October 2015 to September 2016, 137 patients with submandibular gland resected by maxillofacial surgery, affiliated Oral Hospital of Kunming Medical University, were observed, lymph nodes were separated, and anatomic location of lymph nodes was recorded.The pathological data of 82 patients with oral cancer were collected and sorted by histological and pathological examination after operation. The result of pathological examination was final submandibular gland excision, which was the cause of final submandibular gland resection, and the pathological data of 82 patients with oral cancer were collected and sorted out by retrospective study.Statistical pathological data.The characteristics and influencing factors of submandibular gland and lymph node metastasis were analyzed statistically.From February 2016 to April 2017, 54 patients with oral cancer diagnosed and treated in oral and maxillofacial surgery of the affiliated Oral Hospital of Kunming Medical University were studied prospectively.The lymph nodes, submandibular glands and ducts of submandibular glands were separated and frozen for examination. The pathological features of submandibular and submandibular gland ducts and lymph nodes were determined by histopathological examination after operation and the influencing factors were analyzed.[results] the primary disease of submandibular gland was the main cause of submandibular gland excision. The submandibular gland inflammatory lesions and duct stones of submandibular gland were the most common diseases of submandibular gland. The submandibular gland lymph nodes were not found in all cases.The occurrence rate of periglandular lymph nodes and the average number of lymph nodes in benign and malignant submandibular gland varied from one to the other. The difference was statistically significant. 3) the submandibular gland was resected by cervical lymph node dissection, which was mainly normal submandibular gland, accounting for 60%.The submandibular gland was accompanied by chronic inflammation or inflammatory cell infiltration, accounting for about 37. 5%.The submandibular gland showed aging change in 7 cases (4. 5%).Seven.The incidence of inflammatory cell infiltration in the submandibular gland was higher in the older patients and those with primary lesions in contact with the outside world or after breaking. 4) in the histopathological study of submandibular gland ducts, there were 2 cases with tumor embolus in the ductal ducts, but the ducts were not involved.[conclusion] it is relatively common for oral carcinoma to metastasize to the lymph nodes around the submandibular gland, but it is rare to metastasize to the submandibular gland.Therefore, it is theoretically safe to preserve the submandibular gland in lymph node dissection of oral carcinoma at histopathological level.The submandibular gland preservation and submandibular gland transplantation may be considered for oral carcinoma whose primary focus is far from the submandibular gland.The submandibular gland was protected during postoperative radiotherapy.The submandibular gland should be followed up for at least 2-3 years. If recurrence or metastasis is found, reoperation is required.However, there is a lack of randomized controlled trials and evidence of submandibular gland preservation in such studies should be carefully selected.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8

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