【摘要】 目的:探讨对舌根/累及舌根的恶性肿瘤施行经下颌骨正中离断外旋入路切除舌根癌以及同期重建舌根的临床治疗效果。方法:2004年1月至2013年12月收治的37例舌根/累计舌根的恶性肿瘤患者的临床资料.男29例,女8例。舌根原发癌27例,其中鳞癌24例,粘液表皮样癌3例;累及舌根的咽侧、扁桃体鳞癌10例。均经下颌骨正中离断外旋入路。施行单纯舌根切除13例,单侧舌根切除+咽侧切除10例,单侧舌根+半舌切除11例,半舌切除+喉部分切除3例。舌根重建的方法:直接拉拢缝合5例,舌瓣后置6例,全腭瓣3例,带蒂胸大肌皮瓣5例,游离前臂皮瓣12例,游离股前外侧皮瓣6例。11例行双侧颈淋巴清扫术,26例行单侧颈淋巴清扫术。结果:全组肿瘤切除率100%,均未出现残舌坏死,术后吞咽、语言、呼吸和咀嚼功能恢复良好。37例原发灶切缘均呈阴性,21例(56.75%)出现淋巴结转移。除2例行全舌根+喉部分切除的病例终身带管外,其余35例皆在14~38 d拔出气管套管。术后10~28 d拔出胃管经口进食。中位随访时间36个月,Kaplan-Meier法统计3年和5年生存率分别为72.97%(27/37)和67.56%(25/37)。结论:舌根/累及舌根的恶性肿瘤施行下颌骨正中离断外旋入路切除舌根癌以及同期重建舌根的临床治疗效果良好。该术式可以充分暴露口咽和舌根,提高了手术安全性。是比较理想的术式,最大限度保留舌动脉是能否施行单纯舌根切除的和残舌组织能否成活的关键所在。更多还原

【Abstract】 Objective:Study on lingual root/involved the base of tongue malignant tumor were performed after mandibular median interruption and external rotation approach for resection and simultaneous reconstruction of clinical therapeutic effect. Method:From Jan.2004 to Dec. 2013,37 patients suffer from lingual root/involved the base of tongue cancer from Anhui Provincial Hospital of oral and Maxillofacial Surgery Department,clinical data were retrospectively analyzed.Mandibular median interruption and external rotation approach for operation was performed in all cases. The root of tongue resection in 13 cases;midline glossectomy and pharyngeal resection 10 cases;unilateral glossectomy and half of the tongue resection 11 cases;half of the tongue and partial excision of laryngeal 3 cases.The method of reconstruction of the tongue:Direct suture 5 cases;tongue Adjacent flap 6 cases;total palatal flap 3 cases;pectoralis major myocutaneous flap 5 cases;free forearm skin flap 12 cases;free anterolateral thigh flap 6 cases.11 cases performed bilateral lymph node dissection;26cases performed unilateral lymph node dissection. Result:The tumor removal rate reached 100 %,there was no necrosis of the tongue,and The recovery of swallowing,speech,respiration and masticatory function of all patients is good. Negative margin of the primary lesion in 37 cases,21 cases(56.75 %)Lymph node metastasis were found. In addition to the 2 cases of patients need a lifetime with tracheotomy,the rest 36 cases are pulling out the tracheal tube in 14~38 d. Median followup time was 36 months,the survival rates of 3 years and 5 years were 72.57 % and 67.56 % respectively by Kaplan-Meier Method. Conclusion:Mandibular median interruption and external rotation approach which for resection of carcinoma of root of the tongue and simultaneous recons-truction,that the effect of clinical treatment is still good. This operation mode can fully expose the oropharynx and root of the tongue,improve operation safety,to maximize the retention of the lingual artery that is the key whether the implementation of glossectomy and the survival of residual tongue tissue,is a relatively ideal method.更多还原