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目的 探讨累及舌根恶性肿瘤的手术及功能重建。方法 对手术治疗的 5 7例原发舌根及咽喉部累及舌根的恶性肿瘤病人进行总结 ,其中舌根癌 7例 ,软腭癌累及舌根 6例 ,扁桃体癌累及舌根 1 4例 ,声门上区喉癌累及舌根 30例 ,分别实施经口、咽侧、舌骨区、下颌骨正中裂开外旋入路切除肿瘤 ,术后行切除舌根的修复及舌功能重建 ,应用颈阔肌皮瓣、胸骨舌骨肌肌筋膜 (皮 )瓣、颞肌肌筋膜瓣、胸大肌肌皮瓣、喉气管瓣及局部拉拢缝合喉体上提修复缺损。结果 全部病人术后经锻炼逐步恢复了饮食功能 ;除行喉气管瓣修复 5例外 ,全部恢复了言语功能 ;3年、5年生存率分别为 4 0 / 5 7(70 .1 8%)、33/ 5 7(5 7.89%)。结论 术前对肿瘤原发部位及范围的准确评估是选择合适的手术进路、修复方式及彻底切除肿瘤的重要前提 ;适合的手术入路及修复方式 ,在彻底切除肿瘤的同时得以功能重建 ,提高了生活质量 ,可以获得较为理想的治疗效果 ;对这类肿瘤应采取积极有效的综合治疗措施。
Objective To investigate the surgical and functional reconstruction involving tongue base malignancies. Methods Fifty-seven patients with primary tongue and throat involvement and malignant tumor involving the tongue root were reviewed. Among them, 7 cases of tongue root cancer, 6 cases of soft palate and 6 cases of tongue base, 14 cases of tonsil cancer involving tongue base, Thirty cases involving the base of the tongue were treated by perianal, pharynx, hyoid area and mandibular midline debridement, respectively. The resection of the tongue base and reconstruction of the tongue were performed after operation. The platysma flap and the sternal tongue Skeletal muscle myofascial (skin) flap, temporal muscle myofascial flap, pectoralis major myocutaneous flap, laryngotracheal flap and local pull suture laryngeal repair to repair defects. Results All patients gradually recovered their diet function after exercise. Except for laryngotracheal tube flap repair, 5 cases all recovered speech function. The 3-year and 5-year survival rates were 40.0% (70.1%), 33/57 (5 7.89%). Conclusion The accurate assessment of the primary tumor location and extent before surgery is an important prerequisite for selecting appropriate surgical approaches, repair methods and complete resection of the tumor. Suitable surgical approaches and repair methods can be functionally reconstructed while completely removing the tumor, Improve the quality of life, you can get a more satisfactory treatment effect; for such tumors should be taken active and effective comprehensive treatment.