下颌骨舌侧松解进路治疗口腔癌的疗效评价

Mandibular lingual releasing approach to oral cancer:A new non-lip-split access

目的:评价改良手术进路-下颌骨舌侧松解进路(mandibular lingual releasing approach)治疗口腔癌的疗效。方法:回顾性分析2003年7月-2006年12月之间接受下颌骨舌侧松解进路方式治疗的口腔癌病例20例。采用病历对照方法,随机选取性别、年龄、原发部位和分期相当的20例下唇或下颌骨切开进路的患者作为对照组。比较2组的手术并发症、局部复发率和生存率。采用SPSS10.0软件包对数据进行统计学分析。结果:研究组20例,原发灶部位分别为:口底(8例)、舌活动部(6例)、舌根(2例)以及其他部位(4例)。临床I期2例、Ⅱ期4例、Ⅲ期6例、Ⅳ期8例。随访1～40个月,中位随访期15个月。采用Kaplan-Meier方法计算研究组和对照组的3年局部控制率分别为76.2%和64.9%(P=0.792);3年生存率分别为52.3%和50.0%(P=0.672)。研究组和对照组并发症发生率分别是40%和30%(P=0.501)。结论:初步结果显示,与传统下唇裂开或下颌骨切开进路比较,下颌骨舌侧松解进路方式治疗口腔癌,不影响肿瘤治疗效果,既克服了口腔进路受限制以及切除不彻底的弊病,又避免了下唇裂开进路在面部遗留瘢痕的弊端。手术后患者外观改变不明显,生活质量提高。

PURPOSE： To evaluate the feasibility of mandibular lingual releasing approach to oral cancer without lip splitting and the ontological results. METHODS： A case-control study was undertaken for 20 patients with oral cancer who had mandibular lingual releasing procedures at this hospital between July of 2003 and December of 2006. Patients with lip-slitting procedures were randomly selected for control by matched age, sex and stage. The complications, local recurrence and survival result were compared. RESULTS： The subsides of primary tumor were floor of mouth （8）, oral tongue （6）, base of tongue （2） and others （4）. The tumors were staged as follows： 2 in stage I, 4 in stage II, 6 in stage III and 8 in stage IV. The median follow up time was 15 months （range：1-40 months）. The 3-year local control rate was 76.2% for the study group and 64.9% for the control group （P=0.792）.The 3-year survival rate was 52.3% for the study group and 50.0% for the control group （P=0.672）. The rate of complication was not significantly different （40% versus 30%, P=0.501）. CONCLUSIONS： This preliminary study shows that mandibular lingual releasing approach for oral cancer is oncologically safe compared to conventional lip split or mandibulotomy approach. This approach provides direct tumor visualization, resection and reconstruction. Furthermore, it avoids scar caused by lip splitting and may be beneficial to the quality of life.