Schusterman M A, Harris S W, Raymond A K, Goepfert H
Department of Reconstructive and Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Head Neck. 1993 May-Jun;15(3):204-7. doi: 10.1002/hed.2880150305.
The pathologic records of 182 consecutive patients who had mandible resections were reviewed to determine the incidence of positive margins in the bone specimens and the risk factors associated with positive margins. Of the 182 cases reviewed, 82 (45%) were found to have involvement of the mandible at the time of resection and four (2%) were found to have positive margins. The predominant tumor histology was squamous cell carcinoma, 148 of 182 (81%), followed in frequency by osteosarcoma 12 of 182 (7%), salivary gland tumors 13 of 182 (7%), and miscellaneous other tumors (nine of 182 (5%). Of the four tumors with positive margins, two (50%) were squamous cell carcinomas, one (25%) was an osteosarcoma, and one (25%) was a salivary gland tumor. All four tumors were large tumors that had failed to respond to previous therapy. All obviously involved the mandible at the time of presentation. This study demonstrates that the incidence of bone margin involvement after mandibulectomy is rare and predictable and that clinical selection of candidates for immediate reconstruction is reliable in preventing inappropriate use of free bone flaps in patients at risk for positive bone margins.
回顾了182例连续接受下颌骨切除术患者的病理记录，以确定骨标本切缘阳性的发生率以及与切缘阳性相关的危险因素。在回顾的182例病例中，82例（45%）在切除时发现下颌骨受累，4例（2%）发现切缘阳性。主要的肿瘤组织学类型为鳞状细胞癌，182例中有148例（81%），其次是骨肉瘤182例中的12例（7%）、涎腺肿瘤182例中的13例（7%）以及其他各类肿瘤（182例中的9例（5%））。在4例切缘阳性的肿瘤中，2例（50%）为鳞状细胞癌，1例（25%）为骨肉瘤，1例（25%）为涎腺肿瘤。所有4例肿瘤均为大型肿瘤，对先前治疗无反应。所有病例在就诊时均明显累及下颌骨。本研究表明，下颌骨切除术后骨切缘受累的发生率很低且可预测，并且在预防有骨切缘阳性风险的患者不适当使用游离骨瓣方面，临床选择即刻重建的候选者是可靠的。
