本文關(guān)鍵詞：早期舌癌舌頸非連續(xù)性根治和舌交叉瓣重建術(shù)后缺損的生存分析及功能評價　出處：《上海交通大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:研究早期舌鱗癌患者應(yīng)用舌頸非連續(xù)性根治術(shù)式的預(yù)后,分析影響早期舌癌預(yù)后的因素,并評價早期舌癌不同修復(fù)方式對舌語音功能及運動功能恢復(fù)情況。方法:采用回顧性研究的方法,收集1999年12月—2009年12月間在上海第九人民醫(yī)院口腔頜面外科就診采用舌頸非連續(xù)性根治術(shù)式的早期舌體鱗狀細胞癌患者179例,收集完整的臨床病例資料和隨訪資料。采用壽命表法計算遠期生存率,使用SPSS 20.0統(tǒng)計軟件篩選與預(yù)后相關(guān)的影響因素進行單因素及多因素分析。2012年7月至2014年9月在上海第九人民醫(yī)院口腔頜面外科行手術(shù)治療的舌鱗狀細胞癌患者48例,按舌切除后修復(fù)重建的術(shù)式分為舌交叉瓣修復(fù)組(16例)、拉攏縫合組(8例)、頦下島狀瓣修復(fù)組(8例)、前臂皮瓣修復(fù)組(8例)、胸大肌皮瓣修復(fù)組(8例)。采用張大口時的舌最大前伸距離和舌尖偏斜距離作為舌運動功能評價手段,采用漢語語音清晰度測試字表作為語音功能評價手段,收集每例患者術(shù)前、術(shù)后語音清晰度改變差值,利用SPSS 20.0對獲得的資料進行方差分析,評價不同修復(fù)方式對舌語音功能和運動功能的影響。結(jié)果:1.179例早期舌癌患者術(shù)后術(shù)后1、2、3、5年生存率分別為96%、91%、84%、74%。單因素分析篩選出原發(fā)灶大小、病理分級、浸潤深度、是否復(fù)發(fā)4個因素與預(yù)后有關(guān)(log-rank檢驗,P0.05)。多因素分析顯示病理分級、浸潤深度、是否復(fù)發(fā)是生存率的獨立影響因素(Cox多因素分析,P0.05),與預(yù)后密切相關(guān),可獨立影響早期舌癌的遠期療效。2.對于語音清晰度術(shù)前術(shù)后改變差值,舌交叉瓣組與頦下島狀瓣組、前臂皮瓣組無顯著性差異;而與拉攏縫合組、胸大肌皮瓣組相比有顯著性差異(P0.05),舌交叉瓣修復(fù)組拉攏縫合組胸大肌皮瓣修復(fù)組。對于舌最大前伸距離,舌交叉瓣組與頦下島狀瓣組、前臂皮瓣組相比無顯著差異,而與拉攏縫合組、胸大肌皮瓣組相比有顯著差異(P0.05),舌交叉瓣修復(fù)組胸大肌皮瓣修復(fù)組拉攏縫合組;對于舌尖偏斜距離(cm),舌交叉瓣與頦下島狀瓣組、前臂皮瓣組、胸大肌皮瓣組相比均無顯著差異,只有拉攏縫合組與舌交叉瓣組有差異,舌交叉瓣修復(fù)組拉攏縫合組。結(jié)論:1.本組舌交叉瓣重建早期舌癌術(shù)后缺損的病例術(shù)后1、2、3、5年生存率分別為96%、91%、84%、74%。2.早期舌癌(cT1-2N0M0,原發(fā)灶未累及口底)的患者,可行舌原發(fā)灶、頸部非連續(xù)性根治術(shù),并且術(shù)后可獲得更好的生存質(zhì)量。3.原發(fā)灶大小、浸潤深度、病理分級、術(shù)后復(fù)發(fā)是影響早期舌癌預(yù)后的因素。其中浸潤深度、病理分級、術(shù)后復(fù)發(fā)與預(yù)后密切相關(guān),是影響舌癌預(yù)后的獨立因素。4.舌交叉瓣修復(fù)法適用于舌癌≤T2的術(shù)后缺損,修復(fù)后語音清晰度和舌活動度較胸大肌修復(fù)、拉攏縫合高,并不遜色于前臂皮瓣修復(fù)和頦下島狀瓣修復(fù),且大大縮短了手術(shù)的時間,降低了手術(shù)的創(chuàng)傷和風險,是一種較為理想的修復(fù)方法。
[Abstract]:Objective: To study the early application of tongue squamous cell carcinoma of tongue in patients with non continuous neck resection prognosis type, analysis of factors affecting the prognosis of early tongue squamous cell carcinoma, and to evaluate the early tongue cancer of different restoration methods on recovery of motor function and tongue speech function. Methods: using the method of retrospective study, from December 1999 to December 2009 in Shanghai No.9 People's Hospital of oral and maxillofacial surgery clinic the tongue neck non continuous radical resection in patients with early type of squamous cell carcinoma of tongue body in 179 cases, complete collection of the clinical data and follow-up data. The survival rate was calculated by life table method, analysis of.2012 from July to September 2014 in 48 cases of surgical treatment of oral and maxillofacial surgery, Shanghai No.9 People's Hospital for tongue squamous cell carcinoma and single factor many factors using SPSS 20 statistical software selection and prognostic impact, according to the tongue repair after excision of surgical reconstruction The tongue is divided into cross flap group (16 cases), suture group (8 cases), submental island flap repair group (8 cases), forearm flap group (8 cases), pectoralis major myocutaneous flap group (8 cases). The big mouth of the tongue and tongue protrusion distance deviation distance as the tongue movement function evaluation method, using Chinese speech intelligibility test list as the voice function evaluation method, were collected for each patient before surgery, postoperative speech intelligibility change difference, by using the data of SPSS obtained 20 of the variance analysis, evaluation of the effects of different restoration methods on tongue speech function and motor function. Results: 1.179 cases early tongue cancer patients after 1,2,3,5 year survival rates were 96%, 91%, 84%, single factor 74%. analysis of primary tumor size, pathological grade, depth of invasion, recurrence of 4 factors associated with the prognosis (log-rank test, P0.05). Multivariate analysis showed that pathological grading, infiltration The depth of recurrence are independent factors affecting the survival rate (Cox multivariate analysis, P0.05), is closely related with the prognosis, independent of the long-term therapeutic effects of early.2. tongue cancer for changing the difference of speech intelligibility before and after surgery, the tongue flap cross group and submental island flap group, there was no significant difference between the forearm flap group with the suture group; pectoralis major myocutaneous flap group showed a significant difference (P0.05), cross lingual flap suture group group of pectoralis major myocutaneous flap group. The tongue protrusion distance, tongue flap cross group and submental island flap, forearm flap group compared with no significant difference. With the suture group, pectoralis major myocutaneous flap group compared with significant difference (P0.05), cross lingual flap group of pectoralis major myocutaneous flap group suture group; the tongue deviation distance (CM), cross tongue flap and submental island flap, forearm flap, pectoralis major myocutaneous flap group were compared no significant difference Only, the suture group and the tongue flap cross group differences, tongue flap group cross suture group. Conclusion: 1. the tongue cross flap to reconstruct the defect after resection of early tongue cancer patients after 1,2,3,5 year survival rates were 96%, 91%, 84%, 74%.2. early tongue cancer (cT1-2N0M0, primary foci without involvement of export bottom) with feasible tongue primary neck resection non continuity, and can obtain better.3. quality of life after surgery of primary tumor size, depth of invasion, pathological grading and recurrence are the factors affecting the prognosis of early tongue cancer. The depth of invasion, pathological grading, recurrence and prognosis are closely related after the defect is independent factors affecting.4. tongue flap repair method of tongue cancer prognosis cross for tongue cancer is less than T2 after the operation, speech intelligibility and tongue activity of pectoralis major muscle repair after the suture is high, is not inferior to the forearm flap and submental island flap repair, and greatly It is an ideal method to shorten the time of the operation, reduce the trauma and risk of the operation.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R739.86

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