Shen Hong, Zhao En-Min, Xiao Shui-Fang, Qin Yong, Jing Zhi-Bin, Li Tian-Cheng
Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Jul;48(7):573-7.
To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy.
A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy.
All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%.
The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.
评估经舌骨入路切除口咽前壁癌及该手术联合放疗的肿瘤学疗效。
回顾性分析24例口咽前壁癌患者。TNM分期如下：T2期7例，T3期2例，T4期15例；N0期7例，N1期4例，N2期12例，N3期1例。经舌骨入路行肿瘤切除术，其中9例行部分舌切除术+部分喉切除术，7例行部分舌切除术+全喉切除术，7例行全舌切除术+部分喉切除术，1例仅行部分舌切除术。16例采用胸大肌肌皮瓣同步修复舌及咽侧壁缺损，1例修复颈部皮肤缺损。1例采用桡侧前臂游离皮瓣及胸骨舌骨肌皮瓣修复舌及咽侧壁和后壁缺损。2例采用胸骨舌骨肌皮瓣重建舌根。分别有20例和4例患者行双侧及单侧颈淋巴结清扫术。5例患者术前行放疗，16例患者术后行放疗。
所有病例手术切缘均为阴性。病理检查显示17例（70.8%）有颈部淋巴结转移。3例患者术后发生咽皮肤瘘。其中2例在部分舌切除术+全喉切除术并同步行胸大肌肌皮瓣重建术后4天发生咽皮肤瘘，经清创后重新缝合及2周换药后瘘口愈合。另1例在部分舌切除术+部分喉切除术后放疗期间发生咽皮肤瘘，经胸大肌肌皮瓣修复后愈合。17例部分喉切除术患者中，16例在1至6个月内拔除气管套管，语音及吞咽功能良好。另1例因呼吸困难未能拔除气管套管。21例患者随访超过3年，Kaplan-Meier生存分析显示3年总生存率为72.6%。
经舌骨肿瘤切除术是治疗口咽前壁癌的有效手术方法。肿瘤切除后的缺损通常需要用各种皮瓣同步修复。手术联合放疗可获得可接受的疗效。
