不裂开下唇和下颌骨的舌癌及舌根癌手术及修复重建

Clinical application of the combined radical operation without breaking lower lip and mandible for tongue and lingual root carcinoma

目的 为减轻舌癌及舌根癌患者手术后咀嚼、吞咽、语言及外形功能的丧失程度,提高患者术后生存质量,本研究探讨舌癌及舌根癌根治术中不裂开下唇、下颌骨,保留其完整的必要性、可能性及方法.方法 收集2004年1月至2013年12月245例（原发灶T2-T3期,侵犯或不侵犯口底,颈部N0-N3）舌癌及舌根癌手术患者为研究对象（试验组）.术中不裂开下唇及下颌骨,沿口底正中肌肉切开,自下颌骨内侧骨面切开下颌舌骨肌附丽,切穿舌颌沟黏膜,保留下颌舌侧牙龈及部分黏膜,直视下将原发灶及颈清扫标本整体切除,取股前外侧皮瓣一期修复,皮瓣边缘与下颌内侧牙龈及对侧舌创缘缝合.同时收集2000年1月至2004年12月行下唇及下颌骨裂开的舌癌及舌根癌根治术患者120例为对照组,比较两组患者术后外形、功能、治疗效果及淋巴结转移患者术后放疗骨坏死情况.结果 不裂开下唇及下颌骨组（试验组）：顺利整体切除245例患者的肿瘤,术后随访6-36个月,中位随访时间20个月,无原发灶复发病例,3例发生颈部淋巴结复发.咀嚼、吞咽、语言及外形功能恢复良好,疗效满意.术后因淋巴结阳性行放疗者,无一例出现放射性骨坏死.裂开下唇及下颌骨组（对照组）：嚼咀、吞咽及语言恢复尚可,外形欠佳,面部及颈部瘢痕明显.术后因淋巴结阳性行放疗者中11例出现放射性骨坏死.结论 T2-T3期舌癌及舌根癌联合根治术中,保留下唇、下颌骨及牙列的完整是可行的,既能完成手术,又能对患者外形及咀嚼功能保留有积极作用,同时避免了术后放疗骨坏死的风险.

Objective To investigate the clinical applicability and outcomes of the combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap for tongue and lingual root carcinoma.Methods The operation with or without breaking lower lip and mandible was performed respectively in 245 patients （experimental group） and 120 patients （control group）.Results Removal of tumor and neck dissection were conducted successfully in all patients of two groups with no serious postoperative complication.With the follows-up of 6 to 36 months,in the patients of experimental group there was no recurrence for primary sites but 3 cases with neck lymphnode recurrence,the functions of chewing,swallowing and speaking were good,there was no damage to appearance,and no osteoradionecrosis occurred in the lymphnode positive cases after radiotherapy; in the patients of experimental group there was no recurrence for primary sites but 4 cases with neck lymphnode recurrence,the functions of chewing,swallowing and speaking were good,but there was apparent scar in neck and face,and osteoradionecrosis occurred in 11 of lymphnode positive cases.Conclusions The combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap is feasible for tongue and lingual root carcinoma （T2-T3）,which reduces the risk for osteoradionecrosis in lymphnode positive cases after radiotherapy and keeps good appearance for patients.