微波固化治疗在口腔癌中的临床应用--附96例临床总结

背景与目的：微波固化治疗口底癌在保护口腔功能方面的研究较少。本研究旨在探讨微波固化治疗过程中的两种特殊处理方式的意义及出血的预防。方法：回顾性分析经微波固化治疗的96例口腔癌病例,比较清除的固化组织病理学检查阴性组和阳性组生存曲线和复发率,比较手术切缘组织病理学阴性组和阳性组的生存曲线和复发率,分析微波固化的并发症及其防治。结果：固化组织病理学检查阴性组和阳性组生存曲线的差异无统计学意义（Log-rank=0.70,P=0.4033）,原发灶、继发灶和复发灶不明者复发率的差异也无统计学意义（X^2=1.650,0.837,0.003;P=0.684,0.360,0.959）;手术切缘组织病理学阴性组的总体生存时间高于阳性组（Log-rank=6.08,P=0.0136）,但复发率的差异则无统计学意义（X^2=0.327,P=0.567）;96例患者的总体并发症发生率为9.6％,都是可以接受的,微波固化组织清除组的出血发生率较微波固化组织未清除组的低（P=0.013）。结论：舌动脉结扎、固化组织清除、创缘缝扎碘仿纱压迫是防止术后出血的有效方法,但微波固化组织的病理学检查结果对预后没有预测作用。术中宜确保足够的固化治疗范围。微波固化治疗口癌时并发症少且较轻微。

Application of microwave coagulation in treatment of cancer of oral cavity: summary of 96 cases

BACKGROUND & OBJECTIVE: There was few report about the protection of oral function of microwave coagulation in treatment of cancer of floor of the mouth. This study was designed to systematically clarify the principle, operation, treatment of the primary cancer and lymph nodes, efficiency, function of the mouth, complications and indications of the microwave coagulation in treatment of the cancer of the oral cavity. Based on this, the significance of the two special methods and prevention of bleeding during the cause were discussed. METHODS: Ninety-six cases with cancer of oral cavity who were treated with microwave coagulation were analyzed retrospectively. The survival rates and the recurrent rates of those with the coagulated tissue be resected or unresected, and of the positive margin group and the negative margin group were compared for analyzing the complications and prevention of them. RESULTS: The difference of the survival rates of those whose coagulated tissue pathologically positive and negative was insignificant (Log Rank = 0.70, P = 0.4033), and the differences of the recurrent rates of the primary site, secondary site and the uncertain site of them were also insignificant (chi 2 = 1.65, 0.837, 0.003; P = 0.684, 0.36, 0.959). The overall survival rate of the patients with negative margin was better than those of with positive margin (Log Rank = 6.08, P = 0.0136). However, the difference of the recurrent rates of them was insignificant (chi 2 = 0.327, P = 0.567). The total complication rate of 96 patients was 9.6% and all of them were acceptable. The complication rate of those with the coagulated tissue be resected was lower than that of the unresected (P = 0.013). CONCLUSION: Ligating the tongue artery, resecting the coagulated tissue, and packing the wound margin were effective methods to prevent the bleeding. The pathological result of the coagulated tissue could not be used to predict the prognosis. It is best to hold enough treatment range for microwave coagulation. Application of microwave coagulation in treatment of cancer of oral cavity has the advantage of less and slight complications.