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。

Salvage surgery for 18 patients with recurrent oral and oropharyngeal squamous cell carcinoma involving carotid artery: short-term follow-up results

PURPOSE: Outcomes of salvage surgery and carotid artery (CA) management were evaluated in patients with oral and oropharyngeal cancer. METHODS: Eighteen patients with recurrent oral and oropharyngeal squamous cell carcinoma involving CA underwent salvage surgery consisting of extended resection of the tumor, CA resection with and without reconstruction, and CA subadventitial dissection with and without encapsulation. Major tissue defects were reconstructed using composite flaps. RESULTS: One patient showed postoperative transient hemiplegia, and wound dehiscence occurred at the recipient site in 2 patients. Two patients developed carotid blowout. One patient who underwent CA resection and reconstruction suffered from carotid embolism. After 5-42 months of follow-up, 12 patients were disease-free, 2 alive with tumor, and 4 died of local recurrence or distant metastases. CONCLUSIONS: Salvage surgery remains an effective treatment modality. The affected carotid artery should be managed according to preoperative evaluation. Major defects can be reconstructed with a trapezius flap.