当科のけい部郭清例の検討

Abstract

The one hundred and six cases of radical neck dossection (RND) procedures were studied which were performed from Jan. 1975 to Dec. 1982.Of the 89 patients, 65 were males and 24 were females. The greatest percentage of patients were seen during the fifth and sixth decades of their lives. Sites of primary lesions were mandible (containing lower gum 22). tongue (20), floor of mouth (19), maxillary sinus (7), submandibular gland (6), upper gum (5), buccal mucosa (3) and others (7). TNM classifications were as follows: T 1 (5), T 2 (26), T 3 (14), T 4 (30), Tx (10), sarcoma (4); N 0 (44), N 1 (40), N 2 (4), N 3 (1); M 0 (89), M 1 (0). Eighty five percent of all cases were squamous cell carcinoma pathologically.Of the 106 cases of RND, 25 were performed prophylactically, and 81 therapeutically.All cases, contained 21 cases of upper neck dissection.The metastasized cases were pathologically found in 58% of all cases and in 71.6% of the cases which were done therapeutically.The accuracy of clinical diagnosis on cervical metastases was shown because of the high ratio of true positive and true negative, and of a low ratio of false positive and false negative (17.8%, 1.0% respectively).However, the false ratio of mandible (37. 5%) was the highest among other primary lesions. According to results, clinical diagnosis on cervical metastases of the mandible was more difficult than other primary lesions.The pathological positive ratio in the cervical nodes was shown as follows: maxillary sinus, upper gum, buccal mucosa; 100% respectively, floor of mouth; 44.4%, mandible; 36.4%, tongue; 59.1%, submandibular gland; 66.7%.As to the distribution of involved nodes, the majority of them were recognized in submandibular nodes and jugulo-digastric nodes. But there were no involved nodes at all in spinal accessory nodes. In the case of the tongue, they were distributed from the submandibular nodes to the jugulo-omohyoid nodes.In the case of the floor of mouth, buccal mucosa and submandibular gland, they were distributed from the submandibular node to the jugulo-digastic nodes. In both cases of upper gum and the maxillary sinus, they were distributed from the submandibular nodes to the jugulo-carotid nodes.A tendency was found that the prognosis was poorer as the numbers of involved nodes and lower level of cervical nodes increased. The multiple involved nodes always contained either submandibular nodes or jugulo-digastric nodes.In the cases except squamous cell carcinoma, it was clearly recognized that there were more numbers of involved nodes and they were distributed over wide levels and the prognosis was very poor compared with the squamous cell carcinoma cases.