累及舌根的头颈部恶性肿瘤保留吞咽和喉功能的手术方法

目的 探讨保留累及舌根的头颈部恶性肿瘤吞咽和喉功能的有效手术方法.方法 回顾性分析2003年1月至2008年12月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治的31例累及舌根的头颈部恶性肿瘤患者的临床资料,男27例,女4例.舌根原发恶性肿瘤9例,累及舌根的扁桃体鳞癌3例,声门上型喉癌累及舌根11例,下咽癌累及舌根8例.术中按照舌动脉的临床解剖,最大限度保留一侧舌动脉和正常的舌根部组织,若术前CT提示双侧舌动脉受侵犯,行全舌切除;根据喉功能的保护机制,最大限度保留会厌、室带、声带.结果 术后31例患者均未发现残舌坏死.5例行全喉切除术和1例行全舌根切除术的患者终身带管,其余25例皆在14～90 d拔出气管套管并保留喉功能,并于术后10～31 d经口进食.2例累及舌根的下咽癌术后咽瘘,换药治疗2周后愈合;2例舌根癌和1例扁桃体癌累及舌根术后感染皆在2周左右治愈.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79.5%和69.6%.结论 累及舌根的头颈部恶性肿瘤的手术治疗,术中可根据舌动脉的临床解剖和喉功能的保护机制对原发肿瘤和舌根部分切除及修复,是最大限度保留吞咽和喉功能的有效方法.

Swallowing and laryngeal function preserving in surgical treatment of the head and neck tumors involving the tongue root

Objective To investigate the surgical technique which could preserve the swallowing and laryngeal function effectively in the malignant head and neck tumors involving the tongue root. Methods From January 2003 to December 2008,31 cases of malignant head and neck tumors involving the tongue base had been treated in this hospital were retrospectively analyzed. There were 27 males and 4 females in which 9 cases of primary malignant tumor were from the base of tongue;3 cases were from the tonsili, 11 cases were from supraglottic laryngeal carcinoma and 8 cases were from hypopharyngeal carcinoma. Preserved the lingual artery of the reserved side and the normal tissue of the root of tongue according to the clinical anatomy of lingual artery during the operation. If preoperative CT had indicated that bilateral lingual arteries were involved, total glossectomy should have been done. The epiglottis, vocal cords and the ventricular band of larynx was preserved as much as possible for the mechanisms of laryngeal function. Results In this group,residual tongue necrosis did not occurred. One case with total glossectomy didn't remove the trachea cannula. Five had total laryngectomy. The other 25 cases decanulated from 14th days to 90th days postoperatively. The time of oral feeding was started from 10th days to 31th days postoperatively. Two cases with hypopharyngeal carcinoma developed fistula, which were cured by dressing change. Two with root of tongue cancer and 1 with tonsil cancer had postoperative infection and healed in 2 weeks. The median followup time was 36 months,and the Kaplan-Meier 3-years and 5-years survival rates were 79. 5% and 69. 6% respectively. Conclusions In the surgical treatments of the malignant head and neck tumors involving the base of tongue, the excisions and reconstructions of the primary tumor and the involved tongue base according to the clinical anatomy of lingual artery and the protection mechanisms of laryngeal function during the operation was one of the most effective technique to preserve the swollowing and laryngeal function.