Reiter Maximilian, Harréus Ulrich
Department of Otolaryngology and Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany
Department of Otolaryngology and Head and Neck Surgery, Evangelisches Krankenkaus, Dusseldorf, Germany.
Anticancer Res. 2017 Aug;37(8):4233-4237. doi: 10.21873/anticanres.11815.
BACKGROUND/AIM: Total glossectomy without laryngectomy for large tongue carcinomas still remains controversial, as these defects may go along with dramatic effects on respiration, speech and swallowing. As a consequence, these procedures significantly impact quality of life. Therefore, larger case series are rare. Nevertheless, with the development of free tissue transfer, functional reconstruction has become increasingly popular and encouraging results are reported in the literature.
We present our experience with complete glossectomy without laryngectomy and free flap reconstruction. A retrospective monocenter cohort-study was conducted. Reconstructive principles, which in our view lead to optimal functional results, are presented. Oncologic, as well as functional results are reported. Functional results were assessed in terms of swallowing ability, decannulation and intelligible speech.
A total of 14 patients met the inclusion criteria. All patients were reconstructed using an anterolateral thigh flap. Complications occurred in 4 patients, 3 of which developed fistula formation. Oral feeding without the need for a gastrostomy tube was resumed in 11 patients (78.6%), 12 patients (85.7%) were able to be permanently decannulated and speech was at least acceptable in 12 patients (85.7%). The three-year survival was 57.1%.
Following meticulous reconstructive principles, as well as a proper patient selection, total glossectomy without laryngectomy is a feasible treatment option for advanced cancer of the tongue.
背景/目的：对于大型舌癌患者，不行喉切除术的全舌切除术仍存在争议，因为这些缺损可能会对呼吸、言语和吞咽产生显著影响。因此，这些手术会对生活质量产生重大影响。所以，较大规模的病例系列较为罕见。然而，随着游离组织移植技术的发展，功能重建越来越普遍，文献中也报道了令人鼓舞的结果。
我们介绍了不行喉切除术的全舌切除术及游离皮瓣重建的经验。进行了一项回顾性单中心队列研究。阐述了我们认为能带来最佳功能结果的重建原则。报告了肿瘤学及功能结果。从吞咽能力、拔管情况和可理解的言语方面评估功能结果。
共有14例患者符合纳入标准。所有患者均采用股前外侧皮瓣进行重建。4例患者出现并发症，其中3例发生了瘘管形成。11例患者（78.6%）恢复了无需胃造瘘管的经口进食，12例患者（85.7%）能够永久拔管，12例患者（85.7%）的言语至少可接受。三年生存率为57.1%。
遵循细致的重建原则以及恰当的患者选择，不行喉切除术的全舌切除术是晚期舌癌的一种可行治疗选择。
