舌再造术创用新法初步报道

PRELIMINARY REPORT ON A NEW APPROACH TO THE RECONSTRUCTION OF TONGUE

用手术治疗舌癌原发灶,其治愈率与镭锭治疗不相上下。但由于手术要切除舌的相应部分,引起相应的吞咽与说话障碍,病人常不愿接受手术。故我院一般是用镭锭治疗舌癌原发灶。可是有些舌癌放射治疗无效或效果差,只有用手术才有治愈的希望。

In carcinoma of the tongue,our treatment is by applying interstitial radium needles to the tongue in order to preserve its function.After irradiation,when there is local recurrence with extensive involvement of the floor of the mouth,the mandible or even the base of the tongue,radical excision of these extensive lesions involving more than one half or almost the entire tongue,would produce difficulties in swallowing and speaking.In order to preserve these functions,a new method to reconstruct the tongue was devised,using the patient’s own tissue.An island of musculocutaneous flap,consisting of the ribbon muscles of the neck together with the overlying skin,nerve and blood supplies,was made.The descending branch of hypoglossal nerve to the strap muscles should be carefully preserved.All the branches from the superior thyroid artery and vein to the strap muscles were preserved,while the main vessels to the thyroid gland were out close to its fascia.The strap muscles,namely the sternohyoid and sternothyroid were severed at their insertions and origins.Whenever possible,the blood vessels and nerves to the flap from both sides should be preserved.Only when the mobility of the flap had to be greatly increased,could the nerves and blood vessels on one side be severed with caution.Following the excision of the carcinoma of the tongue,either the hyoid or the sternal end of this island of musculocutaneous flap was sutured to the base of the tongue while the anterior or the tip of the tongue was constructed with the other end.Radical neck lymph node dissection was carried out,as a rule,simultaneously.Since the strap muscles are not involved in a radical neck dissection,this reconstruction of the tongue did not interfere with the thoroughness of the dissection.Reconstruction of tongue had been done in five cases,four of which suffered from squamous cell carcinoma and one from adenocarcinoma.The primary lesions of three cases were classified as T4 and two as Tg.All of these cases were so late that their life expectancy was only a few months.Subtotal glossectomies were performed in three cases and slightly more than hemiglossectomies in two cases.All five regained excellent swallowing ability and so far as their speaking ability concerned,four could be understood by others and one by his daughter only.