保留完整下颌骨的舌癌根治术式的探讨

Clinical Application of the Combined Radical Operation Retaining Mandible for Tongue Carcinoma

目的：为减少舌癌患者术后口腔功能的丧失，提高患者术后生存质量，探讨舌癌联合根治术中保留下颌骨完整的必要性、可能性及其方法。方法：收集随访2003年5月至2004年12月本科舌癌手术患者10例（原发灶T2～T1，无明显口底侵犯或口底侵犯〈0．5cm，颈部N0～N3）。同期行舌一颈联合根治术，于正中或颏孔前截断下颌骨，沿颌舌沟切开口底黏膜达舌根处，自下颌骨内侧骨面剥离骨膜及下颌舌骨肌附丽，保留下颌舌侧牙龈及部分黏膜，外展下颌骨，直视下扩大切除原发灶，取自身组织瓣（前臂桡侧皮瓣8例，胸大肌皮瓣1例，股前外侧皮瓣1例）一期修复，皮瓣边缘与下颌内侧牙龈或黏膜缝合，复位下颌骨并以钛板钛钉固定；术后常规放疗。结果：随访6～26个月，无1例于下颌骨内侧切缘部位复发，口腔功能恢复良好。结论：舌癌联合根治术中，通过严格选择病例，保留下颌骨完整是完全可行的。

Objective： To investigate the clinical application of the combined radical operation retaining the mandible with one - stage reconstruction using free flap in the patients with tongue carcinoma. Methods： The combined radical operation retaining the mandible with one - stage reconstruction using free flap was performed in 10 tongue carcinoma patients. Resuits： After 6 to 26 months follow - up, there was no local recurrence. The mouth function was well. Conclusion： The combined radical operation retaining the mandible with one - stage reconstruction using free flap could be used for tongue carcinoma patients who had no invasion in the floor of month or the invasion was less than 0.5 cm.