Guo Yun, Sun Yue, Li Jiancheng, Zong Kaiyang, Hu Kai, Chen Mo
Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,233004,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Aug;35(8):712-717. doi: 10.13201/j.issn.2096-7993.2021.08.009.
To investigate the treatment effect of oral and oropharyngeal cancer resection through oral approach. Forty-eight patients who with oral and oropharyngeal cancer were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2015 to January 2018, and all received preoperative chemotherapy, surgical treatment and postoperative radiotherapy. Among them, twenty-four patients who were treated with tumor resection through oral approach in the experimental group, the other twenty-four patients were treated with tumor resection by external approach in the control group. During the operation, both groups of patients were underwent selective neck lymph node dissection and free skin flap transplantation, and preventive radiotherapy were performed after the operation. The operation time, blood loss, and the positive rate of the wound around the wound and the undercut margin of the two groups were compared, and the survival rate of the skin flap was analyzed. The Kaplan-Meier method was used to calculate the survival rate after 3 years of regular follow-up after surgery, and the difference between the curves of the two surgical methods were compared by the Log-rank test, and the quality of life of patients in one year after operation was investigated and analyzed by Washington University students'quality questionnaire 4. The operation time and blood loss of the experimental group were less than the control group, but the difference was not statistically significant(>0.05). The positive rate of frozen margins in both groups was 0. The flap survival rate was 95.8% in the experimental group and 91.7% in the control group, there was no significant difference between the two groups(>0.05), the overall flap survival rate in the two groups was 93.8%. The survival rates of the experimental group were 91.7%, 83.3%, and 74.8% in the 1-, 2-, and 3-years after surgery, and 87.5%, 79.2%, and 75.0% in the control group, there was no statistically significant difference between the experimental group and the control group(>0.05). The 1-year, 2-year and 3-year overall survival rates of the two groups were 93.1%, 83.7% and 78.8% respectively. Compared with the control group, the scores of appearance, activity, recreation, swallowing, chewing, speech and mood in the experimental group were significantly higher(<0.05). Resection of oral cancer tumors through the oral approach with free skin flap repair is in line with the concept of minimally invasive surgery, which improves the quality of life of patients after surgery while ensuring the survival rate, and is worthy of clinical application and promotion.
探讨经口入路行口腔及口咽癌切除术的治疗效果。2015年1月至2018年1月,蚌埠医学院第一附属医院口腔颌面外科收治48例口腔及口咽癌患者,均接受术前化疗、手术治疗及术后放疗。其中,试验组24例患者经口入路行肿瘤切除术,对照组24例患者经外入路行肿瘤切除术。术中,两组患者均行选择性颈淋巴结清扫及游离皮瓣移植术,并于术后行预防性放疗。比较两组患者的手术时间、出血量、术创周围及切缘下切缘阳性率,并分析皮瓣成活率。采用Kaplan-Meier法计算术后定期随访3年的生存率,采用Log-rank检验比较两种手术方式曲线的差异,采用华盛顿大学学生质量问卷4调查分析术后1年患者的生活质量。试验组的手术时间和出血量少于对照组,但差异无统计学意义(>0.05)。两组切缘冰冻切片阳性率均为0。试验组皮瓣成活率为95.8%,对照组为91.7%,两组间差异无统计学意义(>0.05),两组皮瓣总体成活率为93.8%。试验组术后1年、2年、3年生存率分别为91.7%、83.3%、74.8%,对照组分别为87.5%、79.2%、75.0%,试验组与对照组间差异无统计学意义(>0.05)。两组1年、2年、3年总生存率分别为93.1%、83.7%、78.8%。试验组外观、活动、娱乐、吞咽、咀嚼、言语及情绪评分均显著高于对照组(<0.05)。经口入路行口腔癌肿瘤切除联合游离皮瓣修复符合微创手术理念,在保证生存率的同时提高了患者术后生活质量,值得临床应用推广。