口底及部分下颌骨切除在舌癌根治术中的应用价值  

The Role of Mouth Floor and Segmental Mandible Resection in the Radical Operation of Tongue Cancer

作　　者：张军生[1] 牛怀恩[1] 辛克利[1] 

机构地区：[1]山东聊城市人民医院口腔科,252000

出　　处：《实用癌症杂志》2007年第6期645-647,共3页The Practical Journal of Cancer

摘　　要：目的比较2种方式的舌癌根治术后患者的转移率和生存率,探讨口底和部分下颌骨切除在舌癌根治术中的地位及临床意义。方法将原发灶T2、T3颈部为N0舌癌33例(UICC标准)分为2组。连续性手术组16例,在根治性颈清扫同时于颏孔前离断下颌骨,原发灶、口底及下颌管以上的下颌体与颈清组织一并切除。非连续性手术组17例,将颈清扫和舌癌切除分块完成,不处理口底及下颌骨。结果术后3年连续性手术组转移率为12.50%,非连续性手术组52.94%。3年生存率分别为93.75%和58.82%。均有显著性差异(P=0.029和P=0.043)。结论传统的非连续性舌癌根治术对T2/3期舌癌缺乏彻底性,存在较高的转移或复发风险。口底下颌区确实存在与舌体的淋巴回流关系,连续性舌癌手术暴露清晰并能避免亚临床转移的遗漏,能提高患者术后生存率,该术式值得临床推广应用。Objective To compare the metastatic and survival rates of two types of surgical management and to evaluate the clinical role of mouth floor resection and segmental mandibulectomy in radical operation of tongue cancer. Methods 33 patients with UICC T2 ,T3 ,NO tongue cancer were divided into two groups. In the study group, 16 patients were treated by continous operation including a radical resection of the primary tongue lesion, resection of the floor of mouth, segmental mandible resection upon mandibular canal and neck resection. In the control group, 17 cases were treated by discontinous operation： Neck dissection and primary tumor dissection were performed separated without resection of mouth floor and mandible. Results The 3 year metastatic rate was 12.50% in the study, and 52.94% in the control group, and the difference was statistically significant （P = 0.029）. The 3 year survival rate was 93.57% in the study group and 58.82% in the control group. Patients in the study group had significantly higher survival rate than those in the control group （P = 0.043 ）. Conelusion Traditional discontinous radical operation for tongue c^ncer results in high recurrence and metastasis rate by missing the lymphatic drainage of the mouth floor from the tongue. Continous operation can improve the survival by avoiding the missing of the subclinical metastases

关 键 词：舌癌 口底 下颌骨 颈清扫 

分 类 号：R739.86[医药卫生—肿瘤]