复发性口腔鳞癌挽救性手术近期疗效

目的　探讨不同期复发性口腔鳞癌挽救性手术治疗的疗效。方法　对 30例首次复发的复发性口腔鳞癌患者临床再分期后行挽救性手术并跟踪随访。结果　复发性口腔鳞癌早期患者的总生存时间及无瘤生存时间均比复发进展期者长 ,且复发早期 1年生存率及 1年无瘤生存率均高于复发进展期。结论　对复发性口腔鳞癌进行临床的再分期有利于评价预后及制定治疗方案 ;挽救性手术是复发性口腔鳞癌的有效治疗手段 ,尤其对复发性口腔鳞癌早期的患者     

6 舌癌与其他部位口腔癌患者的生存率是否不同？

口腔鳞癌治疗技术的发展，使依照发病部位判断患者预后变得愈加闲惑。该文旨在回顾口腔鳞癌患者的治疗效果．并确定发病部位是否为患者生存率或无瘤生存率的预后因素。方法：对1993～2003年间233例手术切除的OSCC患者进行回顾性研究，将病例分为2组，舌癌73例，其他部位152例，应用Cox模型对2组的生存率进行比较。对切缘阳性、低分化、侵袭性和晚期患者术后辅助放疗或放化疗。对患者的人口统计学资料、发病部位、肿瘤分期、病理学特点、治疗方法及生存资料进行记录，并应用描述性及Kaplan—Meier曲线进行分析，以确定肿瘤局部控制率和患者无瘤生存率的预后因素。     

18例侵犯颈动脉的复发性口腔、口咽鳞状细胞癌的挽救性手术治疗效果评价

目的：评估晚期口腔及口咽鳞状细胞癌（squamous cell carcinoma,简称鳞癌）的挽救性手术及颈动脉处理的效果。方法：对18例侵犯颈总动脉的复发晚期口腔鳞癌及口咽鳞癌的患者行挽救性手术治疗,包括复发灶扩大切除术、颈总动脉结扎术、颈总动脉重建术、颈总动脉解剖术、颈总动脉包裹术,并用复合组织皮瓣修复组织缺损。结果：1例患者术后暂时性偏瘫,2例患者受区创口开裂,2例患者颈动脉爆裂,1例颈总动脉重建患者术后发生颈动脉栓塞。随访5~42个月,12例无复发,2例带瘤生存,4例死于局部复发或远处转移。结论：挽救性手术可有效治疗侵犯颈总动脉的复发晚期口腔鳞癌和口咽鳞癌。根据术前评估处理受肿瘤累及的颈动脉,术式包括颈总动脉结扎术、颈总动脉重建术、颈总动脉解剖术、颈总动脉包裹术。     

口腔黏膜鳞癌术后复发相关因素的观察和研究

目的：分析影响口腔鳞癌预后及复发的临床病理因素,为进行综合治疗及其预后评价提供临床依据。方法：对407例原发口腔鳞癌患者以病变部位、肿瘤厚度、临床T分期、区域淋巴结转移、治疗方式、手术方式、术后组织学分级等指标研究与口腔鳞癌术后及复发相关的因素。结果：口腔鳞癌术后的复发率与病变部位、肿瘤厚度、临床T分期、区域淋巴结转移及组织学分级等因素有关,诱导化疗联合手术的综合治疗可有效降低口腔鳞癌的复发率。结论：临床工作中,我们应综合分析各种临床病理因素,对与术后复发关系较为密切的因素进行仔细评估,制定出有效的预防措施,提高口腔鳞癌的手术治愈率及生存率,降低复发率。     

口腔颌面部横纹肌肉瘤及综合治疗

目的　探讨口腔颌面部横纹肌肉瘤的诊疗方法。方法　选择1981~2001年在四川大学华西口腔医院颌面外科治疗的横纹肌肉瘤患者共74例,按WHO(1972)的横纹肌肉瘤TNM分期和国际横纹肌肉瘤协作组(1988)对该瘤的临床分期进行分期,探讨横纹肌肉瘤病理分型,临床分期及治疗方法与预后的关系。结果　74例患者中,有 34例行扩大切除术,18例行局部切除术,术后所有患者均接受了不同剂量的放疗,另有22例患者因病变范围广或是儿童而只接受了放疗或者放、化疗联合治疗。随访病例的5年生存率随病期和治疗方案的不同而有显著差异, 肿瘤复发和手术切除边缘及临床分期明显相关。结论　采用扩大切除术加术后放疗对提高本病的治愈率,减少复发有明显效果;晚期或儿童患者采用局部切除联合放、化疗对于提高5年生存率有良好效果。     

水通道蛋白3在口腔鳞癌中的表达及临床意义

目的: 探讨水通道蛋白3（AQP3）在口腔鳞癌中的表达及临床意义。方法: 收集2014年3月—2017年4月盘锦辽油宝石花医院保存的202例口腔黏膜组织石蜡标本。其中健康者41例（对照组）、口腔黏膜上皮异常增生45例（A组）、口腔鳞癌116例（B组）。利用免疫组织化学方法检测3组口腔黏膜组织中AQP3的表达情况,分析口腔鳞癌口腔黏膜组织中AQP3表达与临床病理因素及预后的关系。采用SPSS 18.0软件包对数据进行统计学分析。结果: B组口腔黏膜组织中AQP3阳性表达率显著高于A组和对照组（P<0.05）,A组口腔黏膜组织中AQP3阳性表达率显著高于对照组（P<0.05）。肿瘤侵袭深度>5 mm、临床T4分期、颈淋巴结转移、低分化患者,口腔黏膜组织中AQP3阳性表达率分别高于肿瘤侵袭深度≤5 mm、临床T2分期、无颈淋巴结转移、中高分化患者（P<0.05）。AQP3阳性表达的口腔鳞癌患者,术后3年生存率（65.85%）显著低于阴性表达患者（90.00%,P<0.05）。Cox回归分析显示,肿瘤临床分期、分化程度、颈淋巴结转移情况、AQP3阳性表达率是影响总生存率的独立预后因素（P<0.05）。结论: 口腔鳞癌患者口腔黏膜组织中AQP3阳性表达率显著高于口腔黏膜上皮异常增生者,AQP3表达与口腔鳞癌患者临床分期、颈淋巴结转移、分化程度、肿瘤侵袭深度及总生存率相关。     

原发性腮腺鳞状细胞癌的临床分析

目的回顾性总结分析19例原发性腮腺鳞癌的临床特点、预后的相关因素及治疗策略。方法总结分析1993年3月至2004年2月间收治并经组织病理学证实的原发性腮腺鳞癌19例的临床资料,采用Fisher确切概率法进行分析。结果全组患者在病程中出现颈淋巴转移的概率为68.42%（13/19）,全组3、5年生存率为47.36%和42.10%,无瘤生存7例,带瘤生存1例。术后随访的死亡者中,局部复发6例,颈淋巴转移复发2例,合并有局部复发和颈转移2例,远处肺转移1例。单因素分析仅显示N分期对生存率有影响;而T分期、手术范围、术后病理和是否有血管神经侵犯等对生存率的影响没有统计学意义,究其原因推测与样本含量较小有关。结论原发性腮腺鳞癌的局部复发率和颈淋巴转移率均很高,应用广泛性手术及术后放射治疗是首选的最佳综合治疗方案。     

胸苷磷酸化酶与口腔鳞癌血管新生及预后的关系

目的：探讨胸苷磷酸化酶（TP）与口腔鳞癌（OSCC）临床病理及预后的关系,并研究其与微血管密度（microvessel density,MVD）的相关性。方法：用SP免疫组化法检测63例OSCC中TP的表达水平,利用CD34标记的血管进行MVD计数,对所有病例进行随访。采用SPSS13.0软件包进行统计学分析,以χ2检验分析TP的表达及其与各临床病理因素及MVD间的关系,应用寿命表法完成对病例随访资料的生存状况评价。结果：TP在口腔鳞癌组织中的表达显著高于正常口腔黏膜组织（P〈0.01）;TP的表达与肿瘤的颈淋巴结转移密切相关（P〈0.01）,而与患者性别、年龄、临床分期及病理分化程度无明显相关（P〉0.05）;TP表达阳性组的MVD高于TP表达阴性组（P〈0.05）;TP的表达与MVD呈正相关（P〈0.05）。生存分析显示,TP阴性组的5年生存率高于TP阳性组,术后复发组的TP表达阳性率（90.9%）显著高于术后无复发者（50.0%）（P〈0.05）。结论：TP的表达水平与口腔鳞癌的颈淋巴结转移、血管新生及预后密切相关,可以作为其一项不良因子。     

国家级继续医学教育项目口腔颅颌面肿瘤综合治疗研修班通知

经国家卫生部继续教育委员会批准,由中山大学颅颌面外科中心主办的国家级继续医学教育项目———口腔颅颌面肿瘤综合治疗研修班(编号2004082024),将于2004年9月13日至9月15日在广州举行。本班采用多媒体系统教学,由国内外相关知名专家授课,学员可获Ⅰ类继教学分10分。主要授课内容有口腔颅颌面部肿瘤临床研究新进展及新观念;复发性口腔癌挽救性手术;颅颌根治术;成釉细胞瘤颞下窝颅底复发手术治疗;口腔颅颌面部肿瘤切除后缺损显微外科功能性重建;口腔颅颌面部脉管畸形基础研究与治疗进展;内窥镜手术治疗前颅底肿瘤;口腔颌面部恶性肿瘤放射治…     

口腔鳞癌术后复发相关因素的临床研究

目的:研究分析影响口腔鳞癌预后的临床病理因素。方法:对673例原发口腔鳞癌患者以病变部位、肿瘤生长类型、临床T分期、局部淋巴结转移、治疗方式、术后病理分级以及下颌骨切除方式等指标来研究与口腔鳞癌预后相关的因素。结果:口腔鳞癌术后的复发率与病变部位、肿瘤的生长类型、肿瘤的T分期、区域淋巴结转移及病理分级等因素有关,与治疗方式及颌骨切除方式等因素无关。结论:临床工作中,我们应综合分析各种临床病理因素。对与术后复发率关系较为密切的因素要进行仔细评估,制定出有效的预防措施,提高口腔鳞癌的手术治愈率及生存率。     

Treatment delay in early-stage oral squamous cell carcinoma and its relation to survival

The aim of this study was to investigate the impact of a prolonged treatment delay on survival in patients with primary oral squamous cell carcinoma. The investigators hypothesized that treatment delay affects survival, supposing a poor outcome in patients with prolonged treatment initiation. In addition, a critical treatment delay should be defined.Inclusion criteria were a histopathological diagnosis of primary squamous cell carcinoma of the oral cavity and a surgery-based treatment of the tumor. Patients with a history of previously diagnosed malignancies and patients with distant metastasis at the time of diagnosis were excluded from this protocol. Common clinical and histopathological data were assessed retrospectively. Treatment delay was analyzed for the interval between initial presentation and the date of surgery.A total of 484 patients could be included. Considering early-stage patients, the risk of death increases by 1.8% for each day that the treatment delay is prolonged if all other characteristics do not change (p = 0.0035). In patients with advanced disease, a prolonged treatment delay does not affect the risk of death (p = 0.9134). In terms of progression-free survival, treatment delay tends to be associated with a higher risk of recurrence in early-stage disease, but without being statistically significant (p = 0.0718). For patients with early-stage disease, a treatment delay of 20 days is critical regarding overall survival (p = 0.011). For patients with advanced-stage disease, no significant differences have been observed.As patients with early-stage oral squamous cell carcinoma profit from early treatment initiation, we suggest an acceptable maximum treatment delay of no more than 20 days in the surgical management of these patients.     

术前化疗、放疗及手术治疗中晚期口腔鳞癌的临床研究

目的：探讨术前化疗、放疗联合手术综合方案治疗口腔中晚期鳞癌的临床效果。方法：对经病理确诊的104例口腔中晚期鳞癌患者行术前化疗、放疗1周期,再行联合根治手术。并对患者术后局部复发率、远处转移率、生存率、生活质量、张口度及钛板排斥、感染、断裂等情况进行临床观察。结果：口腔中晚期鳞癌术前化疗、放疗总有效率达98．08％,手术切除率达100％,术后不良反应轻,局部复发率1．92％（2例）,远处转移率2．88％（3例）,出现钛板排斥、感染反应导致张口受限2．88％（3例）。术后患者5年生存率91．35％（95例）。结论：术前化疗、放疗产生积极的抗肿瘤作用,取得满意的临床效果,为进一步手术治疗提供了良好的基础。术前化疗、放疗联合手术综合方案治疗中晚期口腔鳞癌,可提高患者远期生存率,手术切除率,术后不良反应轻。     

Marginal and segmental mandibulectomy in patients with oral cancer: a statistical analysis of 106 cases.

PURPOSE: The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the local control and survival after surgical treatment of oral cancer, according to these 2 different mandibular resection procedures. PATIENTS AND METHODS: We conducted a retrospective study of a 20-year cohort of 106 patients who underwent marginal or segmental mandibulectomy for oral cancer. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the floor of the mouth, mandibular gingiva, retromolar trigone, tongue, buccal mucosa, or oropharynx. The type of mandibular resection and treatment outcome were compared, using an univariate analysis by the Pearson chi(2) test, logistic regression model for multivariate analysis, and Kaplan-Meier method to determine survival. RESULTS: The 5-year observed survival rate was 60.35%. The presence of histologic mandibular invasion increased the local recurrence rate. Early tumor stages (P =.02) were found to be associated with decreased local recurrence rates. Our findings indicate that tumor stage and size of mandibulectomy are more important than the type of mandibulectomy in predicting histologic bone involvement. The cases treated with a greater than 4 cm bone resection showed a lower survival rate than those treated with less than 4 cm mandibulectomy (P =.01). Patients in advanced stages (P =.006) and those with surgical margin (P =.0001) or the bone (P =.003) affected by the tumor showed a statistically significant lower survival rate. However, no statistically significant differences were found between patients treated by marginal or segmental mandibulectomy. CONCLUSIONS: Among the prognostic factors studied, the status of the surgical resection margin, the bony involvement and the size of mandibulectomy affected the prognosis for oral carcinoma. Mandibular conservation surgery is oncologically safe for patients with squamous carcinoma in early stages. The marginal technique was not associated with worse prognosis.     

Extended vertical lower trapezius island myocutaneous flap in reconstruction of oral and maxillofacial defects after salvage surgery for recurrent oral carcinoma.

PURPOSE: The purpose of this study was to explore an effective repair method for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral carcinoma. PATIENTS AND METHODS: Eight patients (6 females and 2 males, mean age, 56.9 years) with recurrent oral squamous cell carcinoma of the tongue (n = 4), oral cavity floor (n = 2), and buccal (n = 2) were treated with salvage surgery, and the oral and maxillofacial soft-tissue defects were reconstructed primarily by extended vertical lower trapezius island myocutaneous flap. RESULTS: No flap failure occurred. The donor sites were closed primarily. There were no disabilities with regard to shoulder motion. Followed up after the operation, the survival period of the patients was 6 to 30 months and the average survival period was 13.1 months. There was 1 recurrent case. All of the patients survived. CONCLUSION: The extended vertical lower trapezius island myocutaneous flap, which is a simple, reliable and large flap, can be preferred as a salvage procedure for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral squamous cell carcinoma.     

Frozen section examination of the margins for resection of squamous cell carcinoma of the lower lip.

OBJECTIVES: Our goal was to evaluate the role of frozen section margin examination in the surgical management of squamous cell carcinoma of the lower lip. MATERIALS AND METHODS: We reviewed frozen section examination of the resection surfaces of 131 consecutive patients surgically treated for squamous cell carcinoma of the lower lip during the period January 1980 to January 1999. When invasive carcinoma or carcinoma in situ was present at the resection surface, the margin was defined as positive and re-resection was performed. RESULTS: A peroperative positive margin was seen in 18 of 131 (14%). In 8 patients (6%), a local recurrence developed. CONCLUSIONS: Frozen section examination for margin assessment in the surgical treatment of lip cancer is a reliable technique to control the radicality of the procedure; a secondary surgical procedure or postoperative radiotherapy can be reduced. However, a tumor-free resection surface does not guarantee that local recurrence will not occur.     

3种方式处理下颌骨对舌鳞癌患者手术预后的影响

目的：探讨舌癌病人下颌骨的不同处理方法与手术远期预后的关系,为舌癌患者的手术选择提供参考。方法：随访71例接受手术治疗的舌癌患者5年,分析术后影响预后因素,评价3种不同的下颌骨处理方式与患者预后的关系。结果：下颌骨处理方式对于舌鳞癌患者生存率有直接影响,其中未处理下颌骨患者5年总体生存率56.3%,边缘性去骨截骨患者的5年总体生存率为53.6%,而节段性截骨患者的仅为51.7%。结论：舌癌的预后不完全由下颌骨的切除方式决定的,而是由其侵袭性决定的,因此对于舌癌患者要根据不同情况选择不同方式处理下颌骨,在提高患者生存率的情况下,尽量保存下颌骨的完整性。     

经首次根治性手术治疗口腔鳞状细胞癌患者的生存相关影响因素分析

目的分析口腔鳞状细胞癌(OSCC)患者的总体生存率,以及影响生存率的临床病理因素。方法采集对首次接受根治性外科手术治疗的78例OSCC患者的临床病理及随访资料进行回顾性分析。对计数、计量资料进行描述性分析;采用Kaplan-Meier法绘制生存曲线;采用COX比例风险回归模型进行单因素和多因素分析,分析患者的生存率及预后相关影响因素。结果最终纳入生存分析的患者共计68例,中位随访时间为63(6~87)个月,5年总体存活率为55.9%,随访期间因OSCC死亡患者的中位生存时间为20.5(6~52)个月。单因素分析表明,临床分期、原发灶大小、淋巴结转移、病理分化及复发转移是影响生存时间的暴露因素(P<0.05);多因素分析表明,病理分化、复发转移是影响生存时间的独立危险因素(P<0.05)。78例OSCC患者中合并发生食道鳞状细胞癌(ESCC)者有4例(5.1%)。结论根据肿瘤的临床分期(TNM分期)、原发灶大小、淋巴结转移、病理分化及复发转移可对患者的生存预后作出一定的预测,其中病理分化及复发转移是影响生存预后的独立危险因素。有吸烟饮酒史的OSCC患者应常规进行ESCC临床筛查。     

Clinical outcomes and prognostic factor analysis after salvage surgery for recurrent squamous cell carcinoma of the oral cavity

The purpose of this study was to analyze the oncological outcomes and predictive factors for successful curative salvage surgery after recurrent oral cavity squamous cell carcinoma. A retrospective study was conducted involving 73 patients who received surgery-based salvage treatment. The pattern of failure for primary treatment was local failure in 29 patients, regional failure in 29 patients, and loco-regional failure in 15 patients. The 5-year overall, loco-regional failure-free, and disease-free survival rates were 54.8%, 58.9% and 49.3%, respectively. Patients with an advanced initial N stage, previous treatment with combined modality therapy, loco-regional recurrence, advanced recurrent T stage, a disease-free survival of less than 8 months prior to salvage, and recurrence in a previously treated field had a significantly worse prognosis. Given the potential surgical morbidity, salvage surgery should be undertaken after careful consultation with patients who have factors for a poor prognosis.