下颌骨裂开外旋切除晚期口咽癌

目的 探讨切除晚期口咽癌的有效手术径路。方法 对采用下颌骨裂开外旋径路切除的17例晚期口咽癌患者进行回顾性分析,其中扁桃体癌13例,软腭癌2例,舌根癌2例。分别采用下颌骨裂开外旋及其联合术式切除肿瘤,以舌瓣、胸大肌肌皮瓣、胸骨舌骨肌肌筋膜瓣、颞肌肌筋膜瓣及额瓣修复缺损。术后均给予放疗。结果 全组肿瘤切除率100％,吞咽、呼吸、语言功能恢复良好。3年生存率为54．5％,5年生存率为40.0％。结论 应用下颌骨裂开外旋及其联合术式切除晚期口咽癌,可充分暴露口咽、声门上、下咽、咽旁间隙及颅底．手术安伞有效。

Mandibular swing procedure for surgical resection of advanced oropharyngeal carcinoma

Objective To explore a better approach to resect the advanced oropharyngeal carcinoma.Methods From 1995 to 2005,17 patients underwent mandibular swing procedure for excision of advanced oropharyngeal carcinoma including:13 tonsillar cancers,2 soft palate carcinomas and 2 lingual root cancers.Surgical procedure was selected according to the lesion.All tumors were reseeted through the mandibular swing approach or its combined approaches.Immediate reconstruction of the surgical defect was done using tongue flap,pectoralis major myocutaneous flap,sternohyoid myofascial flap,temporalis myofascial flap and forehead flap,respectively.After surgical resection of the tumors,all patients received postoperative radiotherapy.Results All patients' advanced oropharyngeal carcinoma were successfully resected as planned through the mandibular swing procedure or its combined procedures without severe complications.Functions of deglutition,respiration and speech were well restored.The 3-and 5-year survival rate was 54.5% and 40%,respectively.Conclusion The mandibular swing procedure and its combined approach is safe and effective in the surgical resection of the advanced oropharyngeal carcinoma, which can provide a good exposure for the oropharynx,supraglottic region,hypopharynx,the parapharyngeal space and the base of the skull.