Submandibular Gland Sparing Neck Dissection

頸部淋巴廓清術中保留下頭睡液腺

施皓(Hao Shih) ； 王東堯(Tung-Yiu Wong) ； 黃振勳(jehn-Shyun Huang) ； 黃則達(Tze-Ta Huang) ； 陳孟延(Meng-Yen Chen) ； 陳畊仲(Ken-Chung Chen)

《臺灣口腔顎面外科學會雜誌》 29卷3期 (2018/09) Pp. 153-163

摘要

Background: The survival rate of oral cavity squamous cell carcinoma (OSCC) reaches a plateau, and it is necessary at that point to improve quality of life(QOL). Saliva is important to oral health, for which the submandibular gland provides 70% of daily production. Neck dissection with gland removal is the traditional guideline in OSCC patients. Reduction of saliva is typically noted postoperatively and impairs QOL due to xerostomia. QOL could be probably improved if the gland could be preserved. Objectives: According to some published papers and our own study, there is rarely any submandibular glands metastasis according to pathology even in a positive level Ib neck. Our idea is to attempt to preserve the submandibular gland since it seems safe to keep it in the neck. Methods: The goal was preservation of the gland in an ipsilateral or contralateral pathological NO neck. Subjective tests for function include saliva flow from the orifice using digital pressure and patient sensation. Furthermore, saliva scintigraphy served as an objective test. Findings and Conclusion: From 2004 to 2016, a total of 58 cases included 59 tumors and 63 necks and glands. There was a failure to complete functional tests in 7 glands due to recurrence or radiotherapy. 4 local recurrences and 3 neck recurrences occurred, on average, after a 33-month follow-up. In 56 glands with tests, 2 cases without saliva flow from the orifice were observed, and 3 patients experienced mild xerostomia. Saliva scintigraphy was done in 24 cases, where 7 cases showed normal function, and 13 cases showed mild xerostomia. The others showed moderate xerostomia. We conclude that our method not only preserves function but also does not increase the risk of recurrence. In other words, we could save not only lives but also QOL.

關鍵字

Neck dissection ； Submandibular gland ； Oral cancer ； Scintigraphy

並列摘要

背景：唾液對於口腔健康十分重要，而下頷腺所分泌之唾液佔全天總量約70%。頸部淋巴廓清合併下頷腺移除手術於口腔癌治療中為傳統手術，然而術後唾液的減少所造成的乾口症，可大幅影響病患的生活品質。有鑒於手術病人存活率已達一定水平，我們試圖找出能改善病患生活品質的治療方式。根據文獻，大多數病理學報告顯示，下頷腺少有淋巴轉移的情形。我們嘗試於頸部淋巴廓清術中保留下頷腺，以期待能在不影響病患癒後情形下，改善病患術後口乾症的情形。研究方法:於2004年至2016年，共58位術前診斷為無頸部淋巴轉移之病人，其中包含59個口腔癌與63側的頸部淋巴廓清術，施行下頷腺保留。並以核醫唾液腺造影，病人主觀，醫師客觀檢視評估乾口症與下頷腺功能。平均追蹤時間為33個月。其中7個下頷腺，4個因放射線治療，3個因頸部淋巴結復發被排除於研究。於56個下領腺中，兩個於臨床觀察上無唾液分泌，三個呈現中度口乾症。24個核醫造影中，僅有4個案例呈現中度乾口症，且並無更嚴重者。根據本篇研究，下頷腺於頸部淋巴廓清術中保留，不僅能保留其功能，並且也未影響到病患癒後，且可進一步增進病患的生活品質。

並列關鍵字

頸部淋巴廓清術 ； 下頷腺 ； 口腔癌 ； 唾液腺造影