舌根癌根治性切除一期舌瓣后置修复术的探讨

Set-back tongue flap with a neurovascular pedicle for repair of tongue base carcinoma

从1990年3月至1997年4月期间,为11例舌根癌病人施行了舌根癌根治性切除一期舌瓣后置修复术。其中9例为放疗后局部复发或放疗后局部未控制者,经施行此手术拯救,2年拯救成功6例,成功率为66.67％(6/9)。2例为首次接受此手术根治性切除者。共7例术后无瘤生存2年以上,2年无瘤生存率为63.64％(7/11)。在手术设计上,应用带有血管神经蒂的游离舌瓣后置修复舌根部分切除所造成的缺损。术后舌瓣不同程度地保持了正常舌的生理功能,病人术后生活质量较高。本文着重介绍此手术的操作方法和适应证。

From March, 1990 to April, 1997, eleven patients were treated in our hospital with the procedure of the set-back tongue flap with a neurovascular pedicle for repair of tongue base carcinoma. Among them, 5 patients had developed a local recurrence and 4 had remained cancer at the primary site after radiotherapy, and 2 had not been treated until the proeedure. A postoperative disease-free survival period was 2 years for 7 patients and 2-year disease-free survival rate was 63.64%. The authors describe a tongue flap with a neurovascular pedicle that is set back into the tongue-base deficient. This one-stage procedure is relatively easy to perform and provides good physiologic results. The set-back flap provides a well-vaseularized flap with great mobility. It also maintains good bulk that undergoes little atrophy. Preservation of the nerve supply seems to give it a dynamic role in rehabilitation of tongue base. The authors describe mainly the performance and suggest some indications for the procedure. The article emphasizes that lateral pharyngotomy and mandibulotomy afford excellent exposure of the entire tonguebase. It provides the standard complete resection of half or more of tongue-base and reconstruction of the tongue-base after resection to be accomplished. [Chinese Arch Otolaryngol Head Neck Surg, 1998; 5 (4): 231～234 From the Department of Head and Neck Surgery, Cancer Hospital, Sun Yat-Sen University of Medical Sciences, Guang Zhou, 510060 (Dr. Wu Guohao)]