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例1,女,46岁。因后牙上方溃疡6月余伴疼痛,拟诊鳞癌收住入院。检查:见右翼下颌皱襞区有一溃烂面约3×2cm~2,基底部宽广,波及软腭部,溃破处表面呈菜花状,触之易出血,张口中度受限。在全麻下行癌肿扩大切除+上、下颌骨部分切除+右颈淋巴清扫+中厚皮片移植修复术(左大腿内侧供皮)。术中先行颈清术,然后扩大切除癌肿,连同上下颌骨及翼内肌等组织,抗癌药物湿敷创面。(由于下、颌颊侧牙龈离病变较远,术中尽量予以保留),缝合时尽量利用游离的牙龈粘膜组织与口底对缝,争取先关闭口底创面,然后切取适当大小的中厚皮片,直接在翼下颌区、颊、上颌骨切除后的松质骨表面上植皮,碘仿纱布打包。病理报告为:鳞癌、淋巴结有癌转移。术后流质饮食2周、配戴斜面导板,以保持健侧(牙合)关系。10d后拆包,皮片成活,在骨面上的表
Example 1, female, 46 years old. Due to ulcers in the back of the teeth after more than 6 months with pain, admitted squamous cell carcinoma admitted admitted. Check: see the right wing of the jaw crease area has a festering surface of about 3 × 2cm ~ 2, the base of a wide area, affecting the soft palate, ulceration at the surface was cauliflower-like, easy to touch the bleeding, mouth limited moderate. In general anesthesia underwent expansion of cancer on the removal of +, partial removal of the mandible + right neck lymph node dissection + medium skin graft repair (left thigh medial for skin). Surgery before neck dissection, and then expand the resection of the cancer, along with the upper and lower jaw and wing muscles and other organizations, anti-cancer drugs wet compress wounds. (Due to the next, the gums far away from the jaw side of the buccal cavity, intraoperative as far as possible to retain), use of gingival mucosa tissue and mouth to sew the gap as possible, to close the mouth bottom wound, and then cut the appropriate size of the thick skin Sheets, directly in the wing jaw area, buccal, maxillary resection cancellous bone surface grafting, iodoform gauze packing. Pathology report: squamous cell carcinoma, lymph node metastasis. Postoperative fluid diet for 2 weeks, wearing a beveled guide to maintain the contralateral (occlusal) relationship. After 10d unpacking, skin survived in the bone surface of the table