77例舌部恶性肿瘤的临床分析

Clinic analysis of 77 cases of malignant tumor in tongue

目的:探讨舌部恶性肿瘤的手术治疗意义及采用游离前臂皮瓣和胸大肌肌皮瓣同期修复舌缺损的临床效果。方法:回顾分析近几年皖南医学院附属弋矶山医院口腔医学中心收治具有完整病历记录的舌部恶性肿瘤77例。58例采用舌颈联合根治术,12例采用舌颌颈联合根治术,白斑、原位癌和透明细胞癌各1例行病灶扩大切除术,2例恶性淋巴瘤活检确诊后给予化疗及放疗治疗,2例鳞状细胞癌活检确诊后未治出院;14例同期即刻修复舌缺损,其中11例采用游离前臂皮瓣,3例采用胸大肌肌皮瓣;9例采用预防性气管切开术。结果:2例鳞状细胞癌未治;2例恶性淋巴瘤行化疗及放疗治疗;手术73例,1例术后3个月局部复发;14例同期即刻修复舌缺损,1例术后6个月死亡。结论:彻底切除原发灶及颈淋巴清扫是手术治疗舌部恶性肿瘤的关键,游离前臂皮瓣和胸大肌肌皮瓣是修复术后舌及舌根缺损的理想材料,可以取得良好的临床效果。

Objective：To evaluate the surgical effect of using flap from forearm or pectoralis major myocutaneous flap in treatment of malignant tumor in tongue.Methods：The data of 77 cases with malignant tumor in tongue were gathered for this retrospective study.Of the 77 cases,58 underwent combined resection of tongue and neck and 12 underwent combined resection of tongue,mandible and neck.Each of the 3 cases with leukoplakia,carcinoma in situ or clear cell carcinoma,respectively,underwent extensive resection of the mass.2 cases of malignant lymphoma received chemotherapy and radiotherapy but another 2 cases of squamous cell carcinoma refused treatment.11 out of the 14 cases were undergone homochronous reconstruction of the tongue by using the flap from forearm and 3,by using pectoralis major myocutaneous flap.Tracheotomy was employed as a preventive measure in 9 cases during the operation.Results：In the total 77 cases,2 cases refused treatment and another 2 just received chemotherapy and radiotherapy.Of the 73 cases undergone surgery,1 complicated with local recurrence 3 months after the operation and another 1 died within 6 months.14 cases were treated with homochronous reconstruction.Conclusion：Treatment of the malignant tumor in tongue requires extensive resection of the mass in tongue and neck,and reconstruction the tongue with forearm flap and pectoralis major myocutaneous flap seems effective.