舌根部恶性肿瘤的手术治疗

Surgical treatment for malignant tumors of the root of tongue

目的发生于舌根部的肿瘤由于位置较为隐匿,多数患者就诊时即处于中晚期,所以其疗效较舌前部的肿瘤差。探讨舌根部恶性肿瘤患者手术治疗的有效性及预后。方法对12例舌根部恶性肿瘤患者手术治疗的临床资料进行回顾性研究和分析。结果 12例舌根部恶性肿瘤患者均行肿瘤扩大切除及颈淋巴结清扫术,其中4例予以局部切除后拉拢缝合,或转舌瓣关闭创面,8例行全舌切除+皮瓣转移修复。经术后随访,1例患者出现下颌骨骨不连,1例出现皮瓣坏死,1例术后1年因肿瘤局部复发死亡,1例因2年后并发肺癌死亡,1例因突然窒息死亡,2例术后1年因营养不良死亡,5例未见复发及转移。结论舌根部恶性肿瘤的手术切除是有效治疗手段,选择合适的手术进路及肿瘤切除后的修复方法,可提高患者的生存质量和治愈率。术后营养支持对患者的预后也较为重要。

Objective Most malignant tumors of the root of tongue are found at the intermediate or late stage,and usually respond less desirably to treatment than those of the anterior tongue.The purpose of this study was to explore the effectiveness and prognosis of surgical treatment of malignant tumors of the root of tongue.Methods We retrospectively analyzed the clinical data of 12 cases of malignant tumor of the root of tongue treated by surgery.Results All the 12 patients underwent extended tumorectomy and cervical gland dissection.Four of them received local excision,the wound closed by suture or with the tongue flap,and the other 8 were treated by total glossectomy followed by tongue flap grafting.On postoperative follow-up,we found 1 case of inferior maxilla nonunion,1 case of flap necrosis,1 death from local recurrence a year later,1 death from lung cancer 2 years later,1 death from sudden asphyxia,and 2 deaths from dystrophy a year later.The other 5 cases experienced no recurrence or metastasis.Conclusion Exairesis is an effective approach to the treatment of malignant tumors of the root of tongue.Appropriate surgical methods can improve the cure rate and the patient′s quality of life,and postoperative nutritional support is important for prognosis.