舌-口底-颈部垂直连续切除在口腔粘膜下纤维性变舌癌变根治中的应用

Management of Vertical and Continuous Resection of Tongue-mouth Floor-neck in Tongue Cancer Patients Accompliced with Oral Submucous Fibrosis

目的探讨舌-口底-颈部垂直连续切除在根治口腔粘膜下纤维性变舌癌变中临床意义。方法收集2004年1月-2008年8月间口腔粘膜下纤维性变舌癌变患者60例(原发灶T2或T3),同期行舌颈联合根治术,术中沿舌部原发灶外安全范围垂直切除至舌骨水平,并沿下颌骨内侧牙龈切开,将舌、口底及颈部淋巴组织作连续切除。同期收集另外一组未行垂直连续切除的口腔粘膜下纤维性变舌癌变患者临床资料54例,比较两组患者间复发率与颈部转移率。结果实验组局部无复发,对侧颈部转移9例,转移率15%。对照组局部复发18例,对侧颈部转移9例,复发转移率50%。差异有统计学意义(P<0.05)。结论舌-口底-颈部垂直连续切除可以明显提高口腔粘膜下纤维性变舌癌变患者临床治疗效果,值得推荐。

Objective To investigate the clinical value of the vertical and continuous resection of tongue- mouth floor- neck in treating the tongue cancer patient accempliced with oral submucous fibrosis. Methods The vertical and continuous resection of tongue - mouth floor - neck was performed in 60 patients. Other 54 patients who had undergone incomplete resection were selected as control group. Recurrence rate and metastasis rate of lymph nodes in cervix of the two groups were compared. Results In experimental group, no recurrence occurred and contralateral lymph node metastasis was seen in 9 cases, with the metastasis rate of 1.5 %. In control group, local recurrence occurred in 18 cases and contralateral lymph node metastasis was seen in 9 cases, with the recurrence or metastasis rate of .50 %. The recurrence or metastasis rate of patients treated with the vertical and continuous resection was significantly lower than that of patients treated with traditional method （ P 〈 0.05）. Conclusion We strongly suggest that the vertical and continuous resection of tongue- mouth floor - neck should be a good way in treating the tongue cancer patient accompliced with oral submucous fibrosis.