摘要
目的探讨下颌骨旁正中劈开手术入路在口咽肿瘤切除术中的可行性,必要性和具体方法及适应证的选择。方法 32例经下颌骨旁正中劈开手术入路行口咽肿瘤切除病例资料回顾,18例鳞癌,11例涎腺和神经源性良性肿瘤,3例涎腺来源恶性肿瘤。肿瘤大小4.0cm×5.0cm～10.0cm×8.0cm。鳞癌病例同期行颈清扫术并采用胸大肌皮瓣,前臂皮瓣或股前外侧皮瓣同期修复。结果 32例患者随访0.5～6年,1例失访。术后随访检查皮瓣完全成活,外形满意,吞咽、咬颌、语音功能3～6个月基本恢复正常。术后发生颌下瘘孔1例,1.5个月后愈合。恶性肿瘤患者发生远隔转移并死亡1例。结论下颌骨旁正中劈开对于大型咽侧良性肿瘤,尤其对未侵及下颌骨、波及多个解剖结构的舌根,咽侧恶性肿瘤是理想的手术进路,其优点是视野好,并发症少,直视下完整大块切除肿瘤有助于减少肿瘤复发,但要注意其适应证的选择。采用游离皮瓣或胸大肌皮瓣进行修复重建能最大程度恢复其功能。
Objective To discuss the feasibility,necessity,indications and method of paramedian mandibulectomy for resection of oropharyngeal tumors.Methods We retrospectively reviewed 32 paramedian mandibulotomy performed between 2004 September to 2010 June.Totally 18 cases of squamous cell carcinoma （SCC）,11 cases of benign tumors and 3 cases of malignant salivary tumors were included.The size of tumors ranged from 4.0 cm×5.0 cm to 10.0 cm×8.0 cm.Selective or modified radical neck dissection and simultaneously reconstructed with pectoralis major myocutaneous flap,radial forearm free flap or anterloateral thigh flap were performed in SCC.The patients were followed up for 6 months to 6 years.Results Except for one missed case and one dead of distance matastasis,no recurrence were found after 0.5 to 6 years follow up.All flaps survived completely and the functions of speech,swallow and occlusion recovered well.Only one case had a postoperative orocutaneous fistula and recovered 1.5 months later.Conclusion Paramedian mandibulotomy can afford wide surgical access enough to resect large benign tumor,especially malignant tumor extending into adjacent anatomic region（sT3 and T4）and benefit to local control of tumor recurrence with en bloc resection.Microvascular free flap and/or pectoralis pedicled flap reconstruction of extensive oropharyngeal defects is safe and reliable for functional and esthetic recovery.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2010年第10期868-870,878,共4页
Journal of China Medical University
基金
国家自然科学基金资助项目(30672331)
关键词
下颌骨
旁正中劈开
口咽
肿瘤
mandible； paramedian mandibulotomy； oropharynx； tumor；
