舌癌连续整块切除血管化(肌)皮瓣修复重建术后的功能评价

Continuous En Bloc Excision of Tongue Carcinoma with Vascular(Myocutaneous) Flap Reconstruction:A Study of Postoperative Functional Assessment

目的评价舌癌连续整块切除同期行血管化(肌)皮瓣修复舌缺损后的语音、咀嚼功能。方法行手术治疗后6～18个月的舌癌患者共47例,其中行前臂皮瓣修复20例(前臂组,半舌以内14例,半舌以上16例),股前外侧肌皮瓣修复27例(股前外侧组,半舌以内15例,半舌以上10例,全舌2例)。采用两因素两水平的析因设计与方差分析比较其语音和咀嚼效率;采用W ilcoxon秩和检验分析比较两个皮瓣组术后的舌颌沟深度改变值。结果与前臂皮瓣组比较,股前外侧组的舌颌沟深度改变值较小(P=0.000),咀嚼效率较优(P=0.035),但语音清晰度较低(P=0.006)。结论股前外侧皮瓣修复更有利于舌癌患者术后的咀嚼和进食,但前臂皮瓣短期内更有利于语音的恢复。

Objective To assess the speech and mastication function after continuous en bloc excision of tongue carcinoma with vascular（myocutaneous） flap reconstruction.Methods 47 tongue cancer cases underwent continuous en bloc excision of tumor,floor of mouth and neck lymph nodes and vascular（myocutaneous） flap reconstruction.Among them,forearm flaps were applied in 20 cases（as forearm group,with defect area was less than hemi tongue in 14 and more than in 6）,and anterolateral thigh cutaneous flaps were performed in 27 cases（as anterolateral-thigh group,with defect area was less than hemi tongue in 15,more than in 10 and total tongue in 2）.The speech and mastication function and tongue-mandibular groove depth were compared between two groups 6～18 months after the surgery. Result The anterolateral-thigh group had better mastication function,less change of tongue-mandibular groove depth,but poor speech function than the forearm flap group（P〈0.05）.Conclusion Anterolateral-thigh cutaneous flap reconstruction is beneficial in mastication function for tongue cancer patients after surgery,but shows no superiority in speech.