不同截骨法治疗下颌牙龈癌的临床疗效分析

Different Mandibulectomy in Treatment of 21 Cases of Mandibular Gingival Cancer

目的:探讨不同截骨方法治疗下颌牙龈癌的临床疗效。方法:回顾性分析21例下颌牙龈癌患者临床资料,并根据下颌骨不同的截骨方案分组和对比分析。其中采用下颌骨边缘性切除9例,下颌骨区段性切除12例,无论何种截骨方案,骨切除边界均距离临床肿瘤边界至少1cm;胸锁乳突肌肌皮瓣修复治疗10例,胸锁乳突肌肌皮瓣+重建钛板修复5例,腓骨肌皮瓣修复4例,胸大肌肌皮瓣+重建钛板修复2例,术后随访2～5年。结果:21例患者,15例患者术后创口一期愈合,6例远端部分发生坏死,延期愈合;19例肿瘤无复发,无淋巴结转移,1例术后8个月局部复发,1例随访期内因食道癌死亡。保留下颌骨下缘的边缘性切除组与区段性切除组患者在手术和住院时间、不良事件发生率方面的差异具有统计学意义;根据肿瘤侵犯范围大小采用不同截骨方案的两组患者在随访期内的复发率、远处转移率的差异无统计学意义。结论:保留下颌骨边缘有利于缩短手术时间、减少手术创伤和并发症,缩短住院时间、提高术后生活质量,只要达到有效边界,对术后肿瘤的复发率、远处转移率无明显负面影响。

Objective To study the different mandibulectomy in treatment of mandibular gingival carcinoma. Methods 21 patients with mandibular gingival carcinoma were retrospectively analyzed, and different section methods were compared in two groups, 9 cases practiced segmental mandibulectomy, 12 cases practiced marginal mandibulectomy. Surgical margin was at least 1 cm beyond tumor in all cases.10 cases were reconstructed by sternocleidomastoid myocutaneous flap, 5 cases were reconstructed by sternocleidomastoid myocutaneous flap and titanium plate, 4 cases were repaired by fibula myocutaneous flap,2 cases were reconstructed by pectoralis major myocutaneous flap and titanium plate. Patients were followed up during next 2 to 5 years. Results 15/21 cases gained stage I healing, 6 cases gained stage II healing after undergo distal necrosis. Local or distant metastasis were not detected in 19 cases, local metastasis was detected in 1 case after 8 months, while 1 case died because of esophageal cancer. Statistic differences are found in surgery time, hospitalization time and adverse events between marginal section group and segmental section group. No statistic difference is found in recurrence or metastasis between the two groups. Conclusion There is no significant difference between different mandibulectomy in treatment of mandibular gingival carcinoma. Different mandibulectomy should be selected according to the scope of lesion. Marginal section reduces surgical and hospitalization time, surgical trauma, complications, improve life quality. Only if safe border is required, there is no difference in recurrence or metastasis between the two groups.