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目的:评价改良手术进路-下颌骨舌侧松解进路(mandibular lingual releasing approach)治疗口腔癌的疗效。方法:回顾性分析2003年7月-2006年12月之间接受下颌骨舌侧松解进路方式治疗的口腔癌病例20例。采用病历对照方法,随机选取性别、年龄、原发部位和分期相当的20例下唇或下颌骨切开进路的患者作为对照组。比较2组的手术并发症、局部复发率和生存率。采用SPSS10.0软件包对数据进行统计学分析。结果:研究组20例,原发灶部位分别为:口底(8例)、舌活动部(6例)、舌根(2例)以及其他部位(4例)。临床I期2例、Ⅱ期4例、Ⅲ期6例、Ⅳ期8例。随访1～40个月,中位随访期15个月。采用Kaplan-Meier方法计算研究组和对照组的3年局部控制率分别为76.2%和64.9%(P=0.792);3年生存率分别为52.3%和50.0%(P=0.672)。研究组和对照组并发症发生率分别是40%和30%(P=0.501)。结论:初步结果显示,与传统下唇裂开或下颌骨切开进路比较,下颌骨舌侧松解进路方式治疗口腔癌,不影响肿瘤治疗效果,既克服了口腔进路受限制以及切除不彻底的弊病,又避免了下唇裂开进路在面部遗留瘢痕的弊端。手术后患者外观改变不明显,生活质量提高。
OBJECTIVE: To evaluate the efficacy of modified surgical approach - mandibular lingual releasing approach in the treatment of oral cancer. Methods: A retrospective analysis of 20 cases of oral cancer treated by means of lingual release from the mandibular joint between July 2003 and December 2006. Patients were randomly selected from 20 cases of lower lip or mandibular approach who had sex, age, primary site and staging equivalent. Comparing the two groups of surgical complications, local recurrence rate and survival rate. SPSS10.0 software package for statistical analysis of the data. Results: In the study group of 20 cases, the primary tumor sites were: the floor of the mouth (8 cases), the active part of the tongue (6 cases), the base of the tongue (2 cases) and the other parts (4 cases). There were 2 cases in clinical stage I, 4 cases in stage II, 6 cases in stage III and 8 cases in stage IV. Follow up for 1 to 40 months, the median follow-up period of 15 months. The three-year local control rates calculated by Kaplan-Meier method were 76.2% and 64.9% for the study group and the control group, respectively (P = 0.792). The 3-year survival rates were 52.3% and 50.0%, respectively (P = 0.672). The incidence of complications in study and control groups was 40% and 30%, respectively (P = 0.501). CONCLUSIONS: The preliminary results show that, compared with traditional lower lip incision or mandibular incision approach, the lingual approach of mandibular loosening treats oral cancer without affecting the therapeutic effect of the tumor, which overcomes the limitation of oral approach and excision Thorough ills, but also to avoid the lower lip split the scar in the face of the drawbacks left over. After surgery, the appearance of the patient did not change significantly, and the quality of life improved.