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目的探索一种既保证早期舌癌根治性手术的彻底性,又最大限度保存或恢复患者术后的机体功能和面颈部美观的最佳手术方式,以提高生存质量。方法 6例早期舌癌患者采用颈部隐蔽性切口、保留颈外静脉、胸锁乳突肌、副神经、耳大神经的颈淋巴清扫联合口内半侧舌、口底扩大切除并行前臂皮瓣即刻修复术式,并对该术式的根治效果、术后功能的保护、口腔功能和面颈部外观等进行评价。结果与常规根治性颈淋巴清扫术相比,颈部切口隐蔽、美观、暴露充分。保留颈外静脉、胸锁乳突肌、副神经和耳大神经可减轻术后面部水肿、保持颈部外观、保存肩功能及耳廓和/或耳后区皮肤感觉功能,而术后颈部控制效果较好,未见复发转移。与常规半舌切除不修复相比,口内半侧舌、口底扩大切除并行前臂皮瓣即刻修复术的根治程度更彻底,舌体的外观以及言语、吞咽、咀嚼等口腔功能均较理想。结论颈部隐蔽性切口、保留颈外静脉、胸锁乳突肌、副神经和耳大神经的颈淋巴清扫联合口内半侧舌、口底扩大切除并行前臂皮瓣即刻修复术是一种治疗早期舌癌比较合理的术式,可在保证舌部病灶和颈部淋巴结根治效果的前提下,减轻和避免了术后面颈部外形的破坏、肩功能损伤、耳部感觉障碍以及言语、吞咽、咀嚼功能障碍,提高了患者术后生存质量。
Objective To explore a way to ensure the thoroughness of radical surgery for early tongue cancer and to maximize the preservation or recovery of the patient’s postoperative body function and facial and neck aesthetic best surgical approach to improve the quality of life. Methods Six cases of early tongue cancer patients were treated with concealed neck incision, cervical jugular fistula, accessory nerve and large auricular nerve neck dissection combined with half tongue of the mouth and enlarged and resected parallel forearm flap immediately Repair operation, and the radical effect of the operation, the protection of postoperative function, oral function and appearance of the face and neck were evaluated. Results Compared with the conventional radical neck dissection, the neck incision hidden, beautiful, fully exposed. Maintaining the external jugular vein, sternocleidomastoid, accessory nerve and large auricular nerve can reduce postoperative facial edema, maintain the appearance of the neck, shoulder function preservation and skin sensory function of the auricle and / or posterior region of the neck, while postoperative neck Control effect is better, no recurrence and metastasis. Compared with the conventional half-tongue resection without repair, the intra-oral half-tongue and mouth enlargement resection parallel forearm flap immediate repair more radical, tongue appearance and speech, swallowing, chewing and other oral function are more ideal. Conclusions The neck concealed incision, the external jugular vein, the sternocleidomastoid muscle, the accessory nerve and the auricular nerve neck dissection combined with the tongue in the mouth and the expansion of the floor of the mouth in parallel with the immediate forearm flap immediate repair is an early treatment Tongue cancer is a more reasonable operation, under the premise of guaranteeing the curative effect of lingual lesion and cervical lymph node, reducing and avoiding postoperative facial and neck shape damage, shoulder dysfunction, ear sensory disturbance and speech, swallowing, Chewing dysfunction, improve patient quality of life after surgery.