论文部分内容阅读
目的:探讨对舌根/累及舌根的恶性肿瘤施行经下颌骨正中离断外旋入路切除舌根癌以及同期重建舌根的临床治疗效果。方法:2004年1月至2013年12月收治的37例舌根/累计舌根的恶性肿瘤患者的临床资料.男29例,女8例。舌根原发癌27例,其中鳞癌24例,粘液表皮样癌3例;累及舌根的咽侧、扁桃体鳞癌10例。均经下颌骨正中离断外旋入路。施行单纯舌根切除13例,单侧舌根切除+咽侧切除10例,单侧舌根+半舌切除11例,半舌切除+喉部分切除3例。舌根重建的方法:直接拉拢缝合5例,舌瓣后置6例,全腭瓣3例,带蒂胸大肌皮瓣5例,游离前臂皮瓣12例,游离股前外侧皮瓣6例。11例行双侧颈淋巴清扫术,26例行单侧颈淋巴清扫术。结果:全组肿瘤切除率100%,均未出现残舌坏死,术后吞咽、语言、呼吸和咀嚼功能恢复良好。37例原发灶切缘均呈阴性,21例(56.75%)出现淋巴结转移。除2例行全舌根+喉部分切除的病例终身带管外,其余35例皆在14~38 d拔出气管套管。术后10~28 d拔出胃管经口进食。中位随访时间36个月,Kaplan-Meier法统计3年和5年生存率分别为72.97%(27/37)和67.56%(25/37)。结论:舌根/累及舌根的恶性肿瘤施行下颌骨正中离断外旋入路切除舌根癌以及同期重建舌根的临床治疗效果良好。该术式可以充分暴露口咽和舌根,提高了手术安全性。是比较理想的术式,最大限度保留舌动脉是能否施行单纯舌根切除的和残舌组织能否成活的关键所在。
Objective: To investigate the clinical efficacy of tongue-root / tongue-covered malignant neoplasms in the treatment of resection of the tongue root cancer through the median circumflex artery and mandibular reconstruction. Methods: From January 2004 to December 2013, 37 patients with malignant tumors with tongue base / base tongue were included, including 29 males and 8 females. There were 27 cases of primary tongue cancer, including 24 cases of squamous cell carcinoma, 3 cases of mucoepidermoid carcinoma, and 10 cases of squamous and tonsil squamous carcinoma involving the base of the tongue. Both the middle of the mandible by external spin-off approach. Thirteen cases of simple tongue resection, unilateral lingual resection + pharyngeal resection in 10 cases, unilateral lingual root + half tongue resection in 11 cases, half tongue resection + throat partial resection in 3 cases. Methods of reconstruction of tongue base: 5 cases were directly sutured and sutured, 6 cases were posteriorly placed with tongue, 3 cases with full palatal flap, 5 cases with pedicled pectoralis major muscle flap, 12 cases with free forearm flap and 6 cases with free anterolateral skin flap. 11 cases of bilateral neck dissection, 26 cases of unilateral neck dissection. Results: The tumor resection rate of the whole group was 100%. No residual tongue necrosis occurred. The postoperative swallowing, language, respiration and chewing function recovered well. All 37 cases had negative margins, and 21 cases (56.75%) had lymph node metastasis. Except for 2 cases with full tongue base and partial laryngectomy, the remaining 35 cases were removed tracheal cannula at 14 ~ 38 days. After 10 ~ 28 d pulled out of the stomach by mouth to eat. The median follow-up time was 36 months. The 3-year and 5-year survival rates were estimated to be 72.97% (27/37) and 67.56% (25/37), respectively, using the Kaplan-Meier method. CONCLUSION: The clinical treatment of tongue base / involved tongue base malignant tumor with median mandibular anterior circumflex artery resection and tongue base resection is good. The procedure can fully expose the oropharyngeal and tongue base, improve the safety of surgery. Is the ideal surgical procedure, the maximum retention of the tongue artery is able to implement a simple tongue resection and tongue cancer survival is the key.