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目的:分析晚期舌癌患者行全舌全喉切除术的疗效。方法:回顾性分析1986～2006年收治的35例晚期舌癌患者的临床资料,其中男26例,女9例,年龄28～70岁,平均51岁;原发舌癌21例,复发舌癌14例;33例为鳞状细胞癌,2例为腺样囊性癌,肿瘤均有不同程度侵犯口底、会厌或喉。所有患者均接受舌癌扩大根治切除,包括全舌全喉切除术,切除后的缺损采用带蒂胸大肌肌皮瓣修复。生存分析采用Kaplan-Meier法,预后分析采用单因素和多因素Cox回归模型。结果:35例患者的皮瓣均成活,其中7例出现皮瓣远端皮肤部分坏死,经换药二期愈合。双侧颈清20例,单侧颈清12例,未作颈清3例,均为复发病例且以前已行根治性颈清。术后局部复发24例,死亡32例。生存分析显示,3年和5年生存率分别为38.7%和23.1%。Cox回归分析显示,肿瘤复发是影响生存和预后的唯一独立因素。结论:扩大根治术对晚期舌癌患者有较好的疗效,带蒂胸大肌肌皮瓣是修复晚期舌癌扩大切除,包括全舌全喉切除后缺损的理想肌皮瓣,在头颈肿瘤修复重建中有重要的临床应用价值。
Objective: To analyze the effect of total tongue laryngectomy in patients with advanced tongue cancer. Methods: The clinical data of 35 patients with advanced tongue cancer admitted from 1986 to 2006 were retrospectively analyzed. There were 26 males and 9 females, aged from 28 to 70 years old (average 51 years old), 21 primary tongue cancer and recurrent tongue cancer 14 cases; 33 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, the tumor has varying degrees of invasion of the mouth, epiglottis or larynx. All patients underwent radical gastrectomy for tongue cancer, including whole-tongue total laryngectomy, and the excised defect was repaired with the pedunculated pectoralis major myocutaneous flap. Survival analysis using Kaplan-Meier method, prognostic analysis using univariate and multivariate Cox regression model. Results: Thirty-five flaps survived. Seven of them showed partial necrosis of the skin of the distal skin and healed by dressing change. Bilateral neck clearance in 20 cases, unilateral neck and neck in 12 cases, 3 cases without neck clearance, were recurrent cases and previously had radical neck clearance. Local recurrence after surgery in 24 cases, 32 patients died. Survival analysis showed that the 3-year and 5-year survival rates were 38.7% and 23.1%, respectively. Cox regression analysis showed that tumor recurrence was the only independent factor affecting survival and prognosis. Conclusion: Extended radical mastectomy has a good curative effect on patients with advanced tongue cancer. Pedicle pectoralis major myocutaneous flap is an ideal myocutaneous flap for the repair of advanced tongue cancer, including complete myectomy. Reconstruction has important clinical value.