摘要：
Objective: To investigate the effect of combined radical resection of tongue cancer without incision of lower lip and mandible on postoperative appearance and dental occlusion and its clinical application in T3-T4 tongue cancer. Methods: A total of 210 patients with T3-T4 tongue cancer in our hospital from January 2013 to December 2016 were retro-spectively analyzed ( primary lesion >4 cm, with or without invasion in floor of the mouth, no invasion in mandible and periosteum, no contraindications to surgery, 153 cases in T3 stage, 57 cases in T4 stage). In total, 143 cases underwent radical resection of tongue cancer without incision of lower lip and mandible (the non-incision group), and 67 cases underwent radical resection of tongue cancer with incision of lower lip and mandible (the incision group). Data of the two groups were compared and analyzed in terms of operation time, surgical hemorrhage, incidence of postoperative free flap crisis, incidence of wound dehiscence, incidence of submandibular fistula, the time to oral intake after surgery, time in which gastric tube was pulled out, length of stay, hospitalization expenses, pa-tients’ satisfaction with appearance of scars, dental occlusion, range of mouth opening, incidence of osteomyelitis caused by operative radiotherapy, recurrence rate 24 months after operation. Results: Compared to the incision group, the average time to oral intake after surgery and the time of feeding tube removal and length of stay were shorter, the influence on mouth open-ing was minor, the occlusal function was better preserved, incidence of osteomyelitis of the mandible and that of infection caused by radiotherapy were significantly lower (P=0. 014) in the non-incision group. In the non-incision group, no patient used high-value consumables such as titanium plates and nails for fixing, and there were no scars on patients’ face. There were no significant differences between two groups in average operation time, average blood loss, free flap crisis, skin flap necrosis, wound dehiscence near residual tongue, wound dehiscence at anterior floor of mouth, wound dehiscence near base of tongue, incidence of submandibular fistula, and recurrence and local recurrence of tumors more than 24 months after oper-ation (P>0. 05). Conclusion: With strict preoperative evaluation, the combined radical resection of tongue cancer without incision of lower lip and mandible and the repair of tongue defects using a free flap are as therapeutically effective as radical resection of tongue cancer with incision of lower lip and mandible for eligible T3-T4 tongue cancer patients. The former is ad-vantageous in that postoperative appearance is satisfactory, postoperative mouth opening and occlusal function are better, trauma is smaller, average time to oral intake after surgery, time of feeding tube removal and length of stay are shorter, hos-pitalization expenses are less, probabilities of osteomyelitis of the mandible and that of infection caused by radiotherapy are lower. There are no significant differences between two strategies in incidence of postoperative complications, cancer recur-rence, average operation time, and average intraoperative hemorrhage. Thus, the method is worthy of clinical popularization.%目的:本研究探讨不裂开下唇及下颌骨的舌癌联合根治术及游离皮瓣舌缺损修复术用于T3-T4期舌癌患者时对术后外观、咬合的影响及临床应用.方法:回顾分析我院2013年1月至2016年12月间收治的T3-T4期舌癌患者210例(原发灶>4cm,侵犯或不侵犯口底,未侵犯下颌骨及骨膜,无手术禁忌症,T3期153例,T4期57例),其中不裂开下唇及下颌骨行舌癌根治术143例(不裂开组),裂开下唇及下颌骨行舌癌根治术67例(裂开组).将两组资料的手术时间、出血量、术后皮瓣危象发生率、口底裂开发生率、口底瘘发生率、恢复经口进食时间、胃管拔除时间、住院天数、外形满意度、咬合、张口度、术后放疗致骨髓炎发生率、术后24个月局部复发率等指标进行对比,分析两种手术方式效果.结果:与裂开组相比,不裂开组平均手术时间无延长,平均失血无增加,平均经口进食、胃管拔除与住院时间更短,所有患者均未使用钛板、钛钉等固定用高值耗材,患者面部均无瘢痕,张口度影响更小,咬合功能保留更好,术后皮瓣危象、皮瓣坏死,皮瓣与残舌、前口底、舌根裂开,口底瘘的发生率无增加,差异均无统计学意义(P>0. 05).需要术后行放疗的患者中,不裂开组患者放疗致下颌骨骨髓炎与伤口感染发生率更低,差异有统计学意义(P=0. 014).不裂开组术后大于24个月口腔局部复发率与总体肿瘤复发率无增加,差异无统计学意义(P>0. 05).结论:在严格的术前评估下,不裂开下唇及下颌骨行舌癌联合根治及游离皮瓣舌缺损修复术的手术方式在符合条件的T3-T4期舌癌患者中的应用,可以达到与裂开下唇及下颌骨行舌癌根治术同样的根治性效果,不仅面部外形保留满意,张口度、咬合功能恢复更好,创伤更小,术后并发症发生率、复发率无增加,手术时间无延长,术中失血无增加,平均经口进食、胃管拔除和住院时间缩短,并且不裂开组术后放疗后发生放射性骨髓炎、伤口感染可能性更低,故该方法值得在临床在推广.
