Matsui Y, Ohno K, Yamashita Y, Takahashi K
Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan.
Int J Oral Maxillofac Surg. 2007 Jul;36(7):601-9. doi: 10.1016/j.ijom.2007.01.014. Epub 2007 Mar 23.
This study investigated postoperative speech function in tongue cancer patients following reconstruction with fasciocutaneous/myocutaneous flaps, to clarify the factor(s) influencing outcome. Eighty-one patients, enrolled from 11 Japanese institutions, were classified into three groups by the site of resection: lateral (N=51), anterior (N=17) and combined (N=13). The lateral group was divided into three subgroups and the anterior group into two subgroups by the size of resection. Mandibulectomy had been performed in 43 patients and radiation therapy in 24 patients. Reconstruction was accomplished by radial forearm flap (N=50), rectus abdominis myocutaneous flap (N=18), pectoralis major myocutaneous flap (N=11), latissimus dorsi myocutaneous flap (N=1) or scapula flap (N=1). Speech function was evaluated with two objective tests and three self-reporting questionnaires. The influence of tongue mobility, age at operation and examination, time interval to examination, and type of flap reconstruction on the functional results was also investigated. Better results were obtained with lateral type resections, smaller excisions, greater tongue mobility, younger patients and longer interval to examination. Mandibulectomy and radiation therapy were negative factors. Type of flap reconstruction had no effect on functional outcome. A treatment method with less functional interference should be developed, particularly for patients anticipated to be in poor functional state postoperatively.
本研究调查了舌癌患者在接受筋膜皮瓣/肌皮瓣重建术后的言语功能,以阐明影响预后的因素。从11家日本机构招募的81例患者,根据切除部位分为三组:外侧组(N = 51)、前部组(N = 17)和联合组(N = 13)。外侧组根据切除范围分为三个亚组,前部组根据切除范围分为两个亚组。43例患者进行了下颌骨切除术,24例患者接受了放射治疗。采用桡侧前臂皮瓣(N = 50)、腹直肌肌皮瓣(N = 18)、胸大肌肌皮瓣(N = 11)、背阔肌肌皮瓣(N = 1)或肩胛骨皮瓣(N = 1)进行重建。通过两项客观测试和三份自我报告问卷对言语功能进行评估。还研究了舌活动度、手术和检查时的年龄、检查间隔时间以及皮瓣重建类型对功能结果的影响。外侧型切除、较小的切除范围、更大的舌活动度、较年轻的患者以及较长的检查间隔时间可获得更好的结果。下颌骨切除术和放射治疗是负面因素。皮瓣重建类型对功能结果没有影响。应开发一种功能干扰较小的治疗方法,特别是对于预计术后功能状态较差的患者。