Righini Stefano, Festa Bianca Maria, Bonanno Maria Chiara, Colombo Valeria, Luca Nicola
Department of Head and Neck Oncologic and Reconstructive Surgery, San Giuseppe Hospital-Multimedica Group.
Università degli Studi di Milano, San Giuseppe Hospital, Milan, Italy.
Laryngoscope. 2019 Jan;129(1):76-81. doi: 10.1002/lary.27176. Epub 2018 Oct 16.
Advanced tongue cancer treated with total glossectomy with laryngeal preservation (TGLP) has a high risk of severe postoperative morbidity due to the loss of swallowing and articulation ability. The purpose of our work is to highlight the potential of the innervated gracilis musculocutaneous flap (IGMF) to permit a good quality of life in patients after undergoing this kind of surgery, particularly when associated with an adequate rehabilitation course.
We are presenting a cohort of 15 patients with T3 or T4 tongue cancer treated with TGLP and dynamic reconstruction with IGMF between 1998 and 2016. Functional outcome data were collected employing flexible endoscopic examination of swallowing, as well as swallowing and speech tests and questionnaires. Our reconstructive procedure was compared with different techniques described in the literature.
In 13 out of 15 patients, a positive functional outcome was recorded, defined as the achievement of an adequate swallowing and speech ability. In two patients, the lack of success was caused by the flap's necrosis and death from early pulmonary metastasis. Of 13 patients, 12 were still alive after 2 years. Ten patients regained an independent feeding by mouth for normal food, whereas three patients continued percutaneous endoscopic gastrotomy supplementation. After 40 months, all 13 patients displayed a moderately intelligible speech capability.
Although TGLP can have devastating morbid effects, an appropriate dynamic reconstruction-along with an adequate course of rehabilitation-can provide good swallowing and articulation outcomes, which permit a satisfactory long-term quality of life.
4 Laryngoscope, 129:76-81, 2019.
采用保留喉功能的全舌切除术（TGLP）治疗晚期舌癌，因吞咽和发音能力丧失，术后严重并发症风险较高。我们研究的目的是强调带神经的股薄肌肌皮瓣（IGMF）在这类手术后让患者拥有良好生活质量的潜力，尤其是在结合适当康复疗程时。
我们报告了一组15例T3或T4期舌癌患者，他们在1998年至2016年间接受了TGLP及IGMF动态重建术。采用吞咽功能的软性内镜检查、吞咽和言语测试及问卷调查收集功能结局数据。我们的重建手术与文献中描述的不同技术进行了比较。
15例患者中有13例记录到了积极的功能结局，定义为实现了足够的吞咽和言语能力。2例患者未成功是由于皮瓣坏死及早期肺转移死亡。13例患者中有12例在2年后仍存活。10例患者恢复了经口独立进食正常食物的能力，而3例患者继续接受经皮内镜下胃造口术补充营养。40个月后，所有13例患者均表现出中等清晰度的言语能力。
尽管TGLP可能产生严重的病态影响，但适当的动态重建以及适当的康复疗程可带来良好的吞咽和发音结局，从而实现令人满意的长期生活质量。
4 喉镜，129:76 - 81，2019年。
