本文選題：口腔癌 + 頜下腺��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]通過組織病理學(xué)分析頜下腺周圍淋巴結(jié)及頜下腺腺內(nèi)淋巴結(jié)的分布情況、頜下腺切除原因、口腔癌患者淋巴結(jié)轉(zhuǎn)移規(guī)律和口腔癌患頸淋巴結(jié)清掃術(shù)中切除頜下腺及其導(dǎo)管的病理學(xué)特點(diǎn)。探討口腔癌頸淋巴清掃術(shù)中保留頜下腺的可行性。[方法](1)選取2015年10月至2016年9月至昆明醫(yī)科大學(xué)附屬口腔醫(yī)院頜面外科診治切除頜下腺的137例患者,術(shù)中對其進(jìn)行觀察,分離淋巴結(jié),并記錄淋巴結(jié)所處解剖位置,術(shù)后通過組織學(xué)病理檢測頜下腺內(nèi)是否存在腺內(nèi)淋巴結(jié),病理學(xué)檢查結(jié)果為最終頜下腺切除原因。(2)采用回顧性研究方法,對符合標(biāo)準(zhǔn)的82例口腔癌患者病理資料進(jìn)行收集整理,統(tǒng)計(jì)病理學(xué)資料。統(tǒng)計(jì)學(xué)分析頜下腺病例特點(diǎn)及其影響因素,淋巴結(jié)轉(zhuǎn)移規(guī)律,頜下腺腫瘤安全性。(3)前瞻性的對2016年2月至2017年4月至昆明醫(yī)科大學(xué)附屬口腔醫(yī)院頜面外科診治的54例口腔癌患者進(jìn)行研究。術(shù)中分離頸部各區(qū)淋巴結(jié)、頜下腺、頜下腺導(dǎo)管并及時(shí)冰凍送檢,術(shù)后通過病理學(xué)組織學(xué)檢查,確定頜下腺及頜下腺導(dǎo)管,淋巴結(jié)的病理特點(diǎn)并分析其影響因素。[結(jié)果](1)頜下腺原發(fā)疾病是切除頜下腺的主要原因,頜下腺炎性病變及頜下腺導(dǎo)管結(jié)石是頜下腺原發(fā)疾病中切除頜下腺比例最高的疾病。(2)所有病例均未發(fā)現(xiàn)頜下腺腺內(nèi)淋巴結(jié),良惡性腫瘤頜下腺腺周淋巴結(jié)出現(xiàn)率及淋巴結(jié)的平均數(shù)不等,差異均具有統(tǒng)計(jì)學(xué)意義。(3)頸淋巴清掃術(shù)中切除頜下腺主要為正常頜下腺,占60. 4%;頜下腺伴有慢性炎癥或有炎性細(xì)胞浸潤,約占37. 6%;頜下腺呈增齡性改變者7例約占4. 7%。高年齡患者及原發(fā)灶直接和外界接觸或破潰后與外界接觸者頜下腺內(nèi)炎性細(xì)胞浸潤發(fā)生率較高。(4)頜下腺導(dǎo)管的病理組織學(xué)研究中有2例(3.6%)導(dǎo)管內(nèi)有癌栓形成,但導(dǎo)管未受累及。[結(jié)論]口腔癌轉(zhuǎn)移到頜下腺周圍淋巴結(jié)相對常見,但轉(zhuǎn)移到頜下腺內(nèi)十分罕見。因此理論上在口腔癌淋巴清掃中保留頜下腺在組織病理學(xué)層面上具有腫瘤安全性。對于原發(fā)灶距離頜下腺較遠(yuǎn)的口腔癌可考慮保留頜下腺并行頜下腺移植術(shù)。術(shù)后放療時(shí)對頜下腺加以保護(hù)。保留頜下腺后應(yīng)進(jìn)行至少2-3年的隨訪,若發(fā)現(xiàn)復(fù)發(fā)或轉(zhuǎn)移者則需再次手術(shù)。但此類研究尚缺乏隨機(jī)對照試驗(yàn),保留頜下腺的證據(jù)尚顯不足,應(yīng)當(dāng)謹(jǐn)慎選擇。
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.8

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