不同下颌骨截骨入路方式在T2~T4期舌癌中的应用价值

The Application Value of Different Mandibular Osteotomy Approaches in T2-T4 Tongue Cancer

目的探讨不同下颌骨截骨入路方式在T2~T4期舌癌中的应用价值。方法随机选取2017年8月—2021年5月东部战区总医院口腔科门诊部收治的76例舌癌患者作为研究对象,所有患者均行舌颌颈联合根治及缺损修复重建术治疗,根据不同下颌骨截骨入路方式分为两组,将采用下颌骨截骨术旁正中入路的37例患者纳入旁正中组,将采用下颌骨截骨术正中入路的39例患者纳入正中组。观察分析两组手术指标、术前和术后6个月、12个月口腔功能,评估临床疗效。结果旁正中组手术时间、术中出血量、术后进食时间、拔除胃管时间及住院时间与正中组比较,差异无统计学意义(P>0.05)。术前两组吞咽、咀嚼和语音功能评分比较,差异无统计学意义(P>0.05);术后6个月,两组吞咽、咀嚼及语音功能评分提高,差异有统计学意义(P<0.05),旁正中组与正中组术后6个月吞咽、咀嚼及语音功能评分相比,差异无统计学意义(P>0.05)。术后12个月,旁正中组吞咽和语音功能评分与正中组比较,差异有统计学意义(P<0.05),两组咀嚼功能评分相比,差异无统计学意义(P>0.05)。旁正中组疾病缓解率为81.08%,与对照组疾病缓解率79.49%相比,差异无统计学意义(χ^(2)=0.030,P>0.05)。结论下颌骨截骨正中入路与旁正中入路治疗T2~T4期舌癌疗效相当,与下颌骨截骨正中入路比较,旁正中入路在促进患者吞咽和语音功能恢复方面更有优势。

Objective To explore the application value of different mandibular osteotomy approaches in T2-T4 tongue cancer.Methods 76 patients with tongue cancer admitted to the outpatient department of the Department of Stomatology,General Hospi⁃tal of the Eastern Theater Command from August 2017 to May 2021 were randomly selected as research objects,and all pa⁃tients underwent combined radical resection of tongue,jaw and neck,and defect repair and reconstruction.According to differ⁃ent mandibular osteotomy approaches,they were divided into two groups.37 patients who used the paramedian approach of mandibular osteotomy were included in the paramedian group,and 39 patients who used the median approach of mandibular os⁃teotomy were included in the median group.Observation and analysis of the two groups of surgical indicators,oral function be⁃fore and 6 months and 12 months after the operation,to evaluate the clinical efficacy.Results There was no statistically signifi⁃cant difference in operation time,intraoperative bleeding,postoperative eating time,gastric tube removal time and hospital stay between the paracentric group and the central group(P>0.05).There was no statistically significant difference in swallowing,chewing and speech function scores between the two groups before operation(P>0.05).At 6 months after operation,the scores of swallowing,chewing and speech function in the two groups were improved,and the difference was statistically significant(P<0.05).Compared with the scores of swallowing,chewing and speech function at 6 months after operation,there was no statisti⁃cally significant difference between the paramedian group and the median group(P>0.05).At 12 months after operation,there was statistically significant difference in swallowing and speech function scores between the paramedian group and the median group(P<0.05),and there was no statistically significant difference in masticatory function scores between the two groups(P>0.05).The disease remission rate of the side center group was 81.08%,and there was no statistically significant difference com⁃pared with 79.49%in the control group(χ^(2)=0.030,P>0.05).Conclusion The median approach of mandibular osteotomy and the paramedian approach have the same curative effect in the treatment of T2-T4 tongue cancer.Compared with the median ap⁃proach of mandibular osteotomy,the paramedian approach has more advantages in promoting the recovery of swallowing and speech function of patients.