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目的分析舌癌口底区淋巴结转移分布的特点,探讨舌癌贯通口底切除的合理术式。方法回顾性分析26例行舌-口底-颈联合根治的舌癌病例,所有患者均行下颌骨舌侧骨膜与舌骨之间患侧口底组织贯通切除的手术方式,将口底区标本分成舌淋巴结和舌动脉起始部淋巴结两组进行病理分析,观察术后口底瘘发生几率和吞咽功能恢复情况,并对术后肿瘤复发转移情况进行随访分析。结果舌淋巴结出现率23.1%(7/26);舌动脉起始部淋巴结出现率15.3%(4/26)。在出现舌淋巴结患者中转移率为71.4%(5/7);在出现舌动脉起始部淋巴结患者中转移率为50.0%(2/4)。术后口底瘘的发生率为7.7%(2/26)。所有患者术后均恢复经口进食。随访期内4例患者发生对侧颈部或咽旁、咽后淋巴结转移,全部26例患者未见原发灶、患侧颌下、患侧舌骨区、患侧颈部复发。结论舌癌贯通口底切除术式符合淋巴引流规律,彻底清扫了口底淋巴引流通路及可能出现的舌淋巴结及舌动脉起始端淋巴结,经临床应用,取得了较好的肿瘤局部及区域转移控制率。
Objective To analyze the characteristics of lymph node metastasis in the oral floor of tongue carcinoma and to explore the reasonable operation of tongue resection. Methods Twenty-six cases of tongue cancer undergoing tongue-mouth-neck combined radical resection were retrospectively analyzed. All patients underwent surgical resection of periosteum and hyoid bone between the lingual periosteum and hyoid bone in the mandible. Divided into tongue lymph nodes and tongue lymph nodes of the initial two groups of pathological analysis of postoperative fistula occurrence and recovery of swallowing function, and postoperative recurrence and metastasis were analyzed. Results The incidence of lingual lymph nodes was 23.1% (7/26). The incidence of lymph nodes in the beginning of lingual arteries was 15.3% (4/26). The metastasis rate was 71.4% (5/7) in patients with lingual lymph nodes and 50.0% (2/4) in patients with lingual node lymph nodes. The incidence of postoperative fistula was 7.7% (2/26). All patients recovered after oral intake. During the follow-up period, 4 patients developed contralateral cervical or parapharyngeal and posterior pharyngeal lymph node metastasis. All 26 patients showed no primary tumor, ipsilateral submaxilla, hyoid area and ipsilateral neck recurrence. Conclusion Tongue resection of the tongue resection method consistent with the law of lymphatic drainage, thorough cleaning of the mouth of the lymphatic drainage pathway and possible tongue and tongue lymph nodes at the beginning of lymph node, clinical application, and achieved good tumor local and regional transfer control rate.