舌癌贯通口底切除的术式探讨

Penetrating resection of the mouth floor in tongue cancer

目的分析舌癌口底区淋巴结转移分布的特点,探讨舌癌贯通口底切除的合理术式。方法回顾性分析26例行舌-口底-颈联合根治的舌癌病例,所有患者均行下颌骨舌侧骨膜与舌骨之间患侧口底组织贯通切除的手术方式,将口底区标本分成舌淋巴结和舌动脉起始部淋巴结两组进行病理分析,观察术后口底瘘发生几率和吞咽功能恢复情况,并对术后肿瘤复发转移情况进行随访分析。结果舌淋巴结出现率23.1%(7/26);舌动脉起始部淋巴结出现率15.3%(4/26)。在出现舌淋巴结患者中转移率为71.4%(5/7);在出现舌动脉起始部淋巴结患者中转移率为50.0%(2/4)。术后口底瘘的发生率为7.7%(2/26)。所有患者术后均恢复经口进食。随访期内4例患者发生对侧颈部或咽旁、咽后淋巴结转移,全部26例患者未见原发灶、患侧颌下、患侧舌骨区、患侧颈部复发。结论舌癌贯通口底切除术式符合淋巴引流规律,彻底清扫了口底淋巴引流通路及可能出现的舌淋巴结及舌动脉起始端淋巴结,经临床应用,取得了较好的肿瘤局部及区域转移控制率。

【Objective】To analysis the distribution of lymphatic metastasis in the mouth floor from the squamous-cell carcinoma of tongue and evaluate the reasonable surgical approach in resection of the floor of mouth.【Methods】Retrospective analysis on 26 patients who were performed mono-block excision with resection of the intermediate tissue of the mouth floor. The pathological examination in the region of mouth floor was divided into lingual lymph nodes and lymph nodes in the root of lingual artery. Post-operative complications evaluation included fistula formation and deglutition disorders. The number and site of local and regional recurrences was followed up after operation. 【Results】The incidence of lingual lymph nodes and lymph nodes in the root of lingual artery was found to be 23.1%（7/26） and 15.3%（4/26）, respectively. The incidence of pathological positive was found to be 71.4%（5/7）in lingual lymph nodes and 50.0%（2/4） in the root of lingual artery. The incidence of fistula in the mouth floor was7.7%（2/26）. The peroral diet recovery was found in all the patients after operation. Metastasis in contralateral neck or parapharyngeal, retropharyngeal was found in 4 patients. No local and regional recurrences in ipsilateral neck, parahyoid,submandible or primary site. 【Conclusions】The penetrating resection of the mouth floor suggested by this paper was in line with the lymphatic drainage in the region of mouth floor. Lymphatic path and the possible lymph nodes could be dissected entirely. The incidence of complication was lower, local and regional recurrences could be controlled satisfactorily.