舌根癌的手术治疗

Surgical treatment of squamous carcinoma tongue in base

目的 探讨4种手术方式治疗舌根癌的疗效。方法 回顾性分析1985～1999年间49例舌根癌,采用4种手术方式治疗,即切除下颌骨升支和/可部分体部的经咽侧人路;保留下颌骨经咽侧入路;切开下颌骨入路;保留下颌骨缘的改良下颌骨部分切除入路。38例舌根缺损采用6种不同的皮瓣或肌皮瓣一期修复。结果 49例舌根癌病人3,5年生存率分别为53.1％,32.7％。手术人路各组间生存率无统计学意义(P>0.05);6种皮瓣或肌皮瓣修复以薄皮瓣及舌瓣术后功能恢复好;有颈淋巴结转移组较无转移组5年生存率明显下降(P<0.05)。结论 为了提高病人的生存质量,在彻底切除肿瘤的前提下,应尽可能保持下颌骨的连续性,舌根缺损宜用较薄肌皮瓣组织修复;对N0舌根癌病人施行颈廓清术是十分必要的。

Objective To evaluate the results of 4 surgical approaches. Methods Forty-nine patients with tongue base cancer were treated with 4 surgical approaches from 1985 to 1999. The 4 approaches included entering by lateral pharyngotomy with partial mandibulectomy, with mandibular being preserved, with mandibular being cut and with mandibular being spared, respectively. Thirty-eight patients were reconstructed with the pedicled musculocutaneous flaps for the defects of tongue base. Results The 3-and 5-year survival rates were 53.1% and 32.7% respectively. No difference in the survival rate was found between the 4 surgical approaches ( P > 0.05). The functional recovery of patients with the thin pedicled musculocutaneous flaps was better than that of those with the thick. Conclusion Keeping mandibular continuation and reconstruction with the thin pedicled musculocutaneous flaps for the defects of tongue base are beneficial to improve the patients' quality of life. It is necessary for tongue base cancer to perform execute neck dissection, even if there is no palpable lymph node metastases.