早期舌癌舌颈非连续性根治和舌交叉瓣重建术后缺损的生存分析及功能评价

发布时间：2018-01-08 01:07

本文关键词：早期舌癌舌颈非连续性根治和舌交叉瓣重建术后缺损的生存分析及功能评价　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究早期舌鳞癌患者应用舌颈非连续性根治术式的预后,分析影响早期舌癌预后的因素,并评价早期舌癌不同修复方式对舌语音功能及运动功能恢复情况。方法:采用回顾性研究的方法,收集1999年12月—2009年12月间在上海第九人民医院口腔颌面外科就诊采用舌颈非连续性根治术式的早期舌体鳞状细胞癌患者179例,收集完整的临床病例资料和随访资料。采用寿命表法计算远期生存率,使用SPSS 20.0统计软件筛选与预后相关的影响因素进行单因素及多因素分析。2012年7月至2014年9月在上海第九人民医院口腔颌面外科行手术治疗的舌鳞状细胞癌患者48例,按舌切除后修复重建的术式分为舌交叉瓣修复组(16例)、拉拢缝合组(8例)、颏下岛状瓣修复组(8例)、前臂皮瓣修复组(8例)、胸大肌皮瓣修复组(8例)。采用张大口时的舌最大前伸距离和舌尖偏斜距离作为舌运动功能评价手段,采用汉语语音清晰度测试字表作为语音功能评价手段,收集每例患者术前、术后语音清晰度改变差值,利用SPSS 20.0对获得的资料进行方差分析,评价不同修复方式对舌语音功能和运动功能的影响。结果:1.179例早期舌癌患者术后术后1、2、3、5年生存率分别为96%、91%、84%、74%。单因素分析筛选出原发灶大小、病理分级、浸润深度、是否复发4个因素与预后有关(log-rank检验,P0.05)。多因素分析显示病理分级、浸润深度、是否复发是生存率的独立影响因素(Cox多因素分析,P0.05),与预后密切相关,可独立影响早期舌癌的远期疗效。2.对于语音清晰度术前术后改变差值,舌交叉瓣组与颏下岛状瓣组、前臂皮瓣组无显著性差异;而与拉拢缝合组、胸大肌皮瓣组相比有显著性差异(P0.05),舌交叉瓣修复组拉拢缝合组胸大肌皮瓣修复组。对于舌最大前伸距离,舌交叉瓣组与颏下岛状瓣组、前臂皮瓣组相比无显著差异,而与拉拢缝合组、胸大肌皮瓣组相比有显著差异(P0.05),舌交叉瓣修复组胸大肌皮瓣修复组拉拢缝合组;对于舌尖偏斜距离(cm),舌交叉瓣与颏下岛状瓣组、前臂皮瓣组、胸大肌皮瓣组相比均无显著差异,只有拉拢缝合组与舌交叉瓣组有差异,舌交叉瓣修复组拉拢缝合组。结论:1.本组舌交叉瓣重建早期舌癌术后缺损的病例术后1、2、3、5年生存率分别为96%、91%、84%、74%。2.早期舌癌(cT1-2N0M0,原发灶未累及口底)的患者,可行舌原发灶、颈部非连续性根治术,并且术后可获得更好的生存质量。3.原发灶大小、浸润深度、病理分级、术后复发是影响早期舌癌预后的因素。其中浸润深度、病理分级、术后复发与预后密切相关,是影响舌癌预后的独立因素。4.舌交叉瓣修复法适用于舌癌≤T2的术后缺损,修复后语音清晰度和舌活动度较胸大肌修复、拉拢缝合高,并不逊色于前臂皮瓣修复和颏下岛状瓣修复,且大大缩短了手术的时间,降低了手术的创伤和风险,是一种较为理想的修复方法。
[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.

【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R739.86

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