摘要
目的:运用循证医学方法,为1例舌鳞状细胞癌(TSCC)T2N0M0患者颈淋巴结的处理选择最佳治疗方案。方法:计算机检索Up to Date、Cochrane Library、PubMed和CNKI数据库,查找关于TSCC患者N0期颈淋巴结处理的证据概要、系统评价、Meta分析、临床随机对照试验等,并对所获证据采用GRADE系统进行评价,所有数据库检索时间为建库至2010年9月1日。再结合医师经验、患者情况及意愿制定治疗方案。结果:当前最佳证据显示选择性颈淋巴结清扫术(END)的癌症死亡例数和淋巴结复发/转移例数显著低于观察组,GRADE证据等级均为中级。结合医师经验和患者意愿及要求,经患者同意,采用肩胛舌骨上颈淋巴结清扫术。随访至今,患者生活基本未受影响,无复发,对治疗满意。结论:对于非高龄TSCC T2N0M0患者,对其颈淋巴结行END可能优于观察。但对其长期效果及对于高龄患者是否利大于弊仍需进一步验证。
Objective To explore a reasonable management of neck lymph nodes for a tongue squamous cell carcinoma patient of T2N0M0 stage,by application of an evidenced-based practice.Methods The Up to Date,the Cochrane Library,PubMed,and CNKI databases were searched up to 1st Sep,2010,to identify the relevant evidence profiles,systematic reviews,meta-analyses,and randomized controlled trials of treating neck lymph nodes of oral cavity cancer at cN0 stage.The quality of collected clinical evidence was evaluated by using GRADEprofiler 3.2 software.The treatment protocol was made on the best evidence,physician experience,and patient will and value choice.Results The currently evidence showed that elective neck dissection(END) was better than obversation,the level of evidences were all moderate.Combined with physician experience,patient will and value choice,and with the patients' consent,then the supraomohyoid ND was performed.There were no recurrence and influence of quality of life,and the patients satisfied with treatment as yet.Conclusion The END would be better than observation for non-elder patients with oral cavity cancer at T2N0M0 stage.Whether the benefits outweigh the disadvantages of long-term effects and elder patients still need further verification.
出处
《湖北医药学院学报》
CAS
2012年第2期97-100,共4页
Journal of Hubei University of Medicine
基金
湖北省教育厅科学技术研究计划2012年度重点项目(D20122405)
湖北医药学院2011年度优秀中青年科技创新团队项目(2011CZX01)
关键词
舌鳞状细胞癌
颈淋巴结
选择性颈淋巴结清扫术
循证治疗
循证实践
Tongue squamous cell carcinoma
Neck lymph nodes
Elective neck dissection
Evidence-based treatment
Evidence-based practice
