唇癌的外科治疗与即时唇再造——兼论保存口角轴在唇再造术中的意义

Surgical Removal of the Lip Cancer and Immediate Lip Reconstruction——Discussion of Reserving the Oral Commissure Modiolus in Lip Reconstruction

目的评价唇癌根治切除后即时进行唇再造的方法与效果。方法对69例唇癌患者,癌切除后即时应用交叉唇瓣、扇形瓣、鼻唇沟或唇颊沟组织瓣、V形切除推进缝合、面动脉蒂的唇颊组织岛状瓣等方法进行唇再造。术后随诊1～6年,观察其形态与功能效果。结果所有患者术后病情稳定,再造唇均成活。再造唇中保存口角轴的53例,其功能与形态效果均优良。应用扇形瓣或口角唇组织瓣转移修复者13例,术后唇形前突,运动时口角不对称。因组织量不足和术后感染致唇形态欠佳者3例。结论①鉴于唇癌容易早期发现,一般恶性程度较低,唇癌切除即时进行唇再造可作为一个常规的治疗方法。②口角轴是口唇运动和表情形态的核心。保存口角轴的唇再造,可使再造唇的形态与功能的损害减少到最低限度。全部割断口角轴的唇再造,必导致再造唇形态与功能的严重损害。交叉唇瓣是一个首选的方法。

Objective To evaluate the effect of lip reconstruction methods after radical resection of the lip cancer.Methods 69 patients with lip cancer underwent radical resection and the lip defects were reconstructed with Abbé lip flaps, fan-shaped flaps,nasolabia flaps,V-Y advanced flaps and island cheek flaps carried by facial artery.The patients were followed up for 1 to 6 years.Results All the flaps for lip reconstruction survived completely and all the patients went through stably.The function and appearance of the reconstructed lip were satisfied in 53 cases whose oral commissures were reserved.13 cases with fan-shaped flaps or oral commissure local flap had protruded lip appearance and dynamical asymmetry at oral commissure.Ideal appearance did not achieved in 3 cases due to infection and not enough tissue coverage.Conclusion ①The lip cancer can be detected at an early stage with lower malignancy.Immediate lip reconstruction can be performed as a routine after the radical resection.②Oral commisure modiolus is the key for lip movement and expression.Lip reconstruction with reserved oral commissure causes slight damage for the lip function and cosmetic appearance.The lip function and appearance can be severely affected when the oral commissure modiolus is cut off.The best method for lip reconstruction is Abbé lip flap.