保持下颌骨连续性的改良型边缘性下颌骨切除在舌癌联合根治术中的应用评价

目的:探讨保持下颌骨连续性的改良型边缘性下颌骨切除在舌癌联合根治术中的应用,评价其的手术方法、操作要点、适应症和临床效果。方法:对2007年1月~2012年12月,应用保持下颌骨连续性的改良型边缘性下颌骨切除的舌癌137例。改良型即是增加了往复锯和磨头对下颌下缘内侧和口底黏膜连接处的骨组织进行片切和选磨。选择性/根治性颈淋巴清扫术,拉拢缝合/带蒂/游离皮瓣移植行舌、口底重建再造。术后30个月以上的随访观察。结果:术后随访均达到30个月以上,中位随访时间42个月。3 、5 年生存率分别为74.45 %(101/137)和70.80 %(97/137)。术后的咀嚼、吞咽、语言和外形的丧失程度有较大的改善,无一例发生病理性骨折,疗效比较满意。结论:保持下颌骨连续性的改良型边缘性下颌骨切除、舌癌联合根治术对中期舌癌是一种可行的根治性手术,既能完成根治性,又能对患者的外形和功能保留有积极的作用。手术的关键是掌握好适应症,同时要求术者具备相当的经验和手术技巧。

Effects of Modified Marginal Resection of Mandible Remaining Its Continuity with Cmbined Radical Neck Dissection in the Surgical Management of Tongue Squamous Cell Carcinoma

Objective: To investigate the feasibility of modified marginal resection of mandible remaining its continuity with combined radical neck dissection in the surgical management of tongue squamous cell carcinoma. Method: Modified marginal resection of mandible remaining its continuity with combined radical neck dissection was used in 137 cases of tongue squamous cell carcinoma. In the modification group, slice cut and selective grinding of bone between inner inferior border of mandible and mucosa of floor of mouth were added. Selective/radical neck dissection was applied. 30-month follow-up was conducted at least. Results: The median follow-up time was 42 months. Three- or five-year survival rate was 74.45% (101/137) and 70.80% (97/137), respectively. Mastication, swallowing, speech and appearance of all the cases were significantly improved. The curative effect was satisfactory. Conclusion: Modified marginal resection of mandible remaining its continuity with combined radical neck dissection is feasible in the treatment of tongue squamous cell carcinoma.