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摘要: 目的 探讨经口入路行口腔-口咽癌恶性肿瘤切除游离皮瓣修复的治疗效果。方法 选取2015年1月—2018年1月蚌埠医学院第一附属医院口腔颌面外科收治的口腔-口咽癌患者48例，均行术前化疗、手术治疗及术后放疗。其中采用经口入路行肿瘤切除(实验组)24例，经口外入路行肿瘤切除(对照组)24例。两组患者术中均行选择性颈淋巴结清扫术、游离皮瓣移植修复，术后均行预防性放疗。对两组病灶切除手术时间、出血量及创面四周、底切缘阳性率进行比较；分析皮瓣存活率；术后定期随访3年采用Kaplan-Meier法计算术后生存率，用Log-rank检验比较两种术式生存曲线间差异；并采用华盛顿大学生存质量问卷表(第4版)调查分析两组患者术后1年的生存质量。结果 实验组经口入路病灶切除手术时间及出血量少于对照组，但差异无统计学意义(P>0.05)。两组冷冻切缘阳性率均为0。实验组皮瓣存活率为95.8%，对照组为91.7%，两组之间差异无统计学意义(P>0.05)，两组皮瓣总体存活率为93.8%。实验组术后第1、2、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%，实验组与对照组之间差异无统计学意义(P>0.05)；两组患者术后第1年、第2年、第3年总体生存率分别为93.1%、83.7%、78.8%。与对照组比较，实验组外貌、行动、娱乐、吞咽、咀嚼、语言、情绪评分均升高，差异有统计学意义(P < 0.05)。结论 经口入路行口腔-口咽癌肿瘤切除游离皮瓣修复符合微创外科理念，在保证生存率的同时提高了患者术后生存质量，值得在临床应用及推广。Abstract: Objective To investigate the treatment effect of oral and oropharyngeal cancer resection through oral approach.Methods 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.Results The operation time and blood loss of the experimental group were less than the control group, but the difference was not statistically significant(P>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(P>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(P>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(P < 0.05).Conclusion 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.
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表 1 口腔-口咽癌患者的基本临床特征
项目 例数 对照组
(n=24)实验组
(n=24)χ2 P 项目 例数 对照组
(n=24)实验组
(n=24)χ2 P 性别 0.087 0.768 T分期(化疗后) 0.410 0.875 男 29 15 14 T1 13 7 6 女 19 9 10 T2 21 11 10 发病部位 2.115 0.833 T3 14 6 8 舌 22 12 10 N分级(化疗前) 0.345 0.842 软腭 4 1 3 N0 28 13 15 颊 10 4 6 N1 11 6 5 上颌牙龈 4 2 2 N2 9 5 4 口底 5 3 2 N分级(化疗后) 0.792 0.673 扁桃体 3 2 1 N0 32 15 17 肿瘤分期 0.751 0.386 N1 10 5 5 Ⅲ期 23 13 10 N2 6 4 2 Ⅳ期 25 11 14 病理类型 0.762 0.483 T分期(化疗前) 0.753 0.686 鳞状细胞癌 27 12 15 T2 7 4 3 黏液表皮样癌 14 8 6 T3 16 9 7 腺样囊性癌 7 4 3 T4a 25 11 14 皮瓣 0.173 0.735 腓动脉穿支皮瓣 26 6 20 前臂皮瓣 22 18 4 
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表 2 实验组和对照组患者术后1年UW-QOL量表评分比较
分，x±s 项目 实验组 对照组 t P 疼痛 91.67±12.04 88.52±12.74 1.000 0.328 外貌 95.83±9.52 64.58±12.59 11.519 0.000 行动 93.75±11.06 77.08±16.35 4.000 0.001 娱乐 96.67±12.04 78.13±21.25 3.186 0.004 吞咽 83.50±16.85 59.75±24.23 3.653 0.001 咀嚼 70.83±25.18 47.92±31.20 2.696 0.013 语言 73.88±13.69 65.58±6.94 2.297 0.031 肩部功能 93.13±13.69 86.25±16.62 1.551 0.135 味觉 75.00±16.48 70.83±22.92 0.723 0.447 唾液分泌 84.88±16.80 73.63±27.87 0.576 0.129 情绪 93.13±13.69 74.96±30.02 2.855 0.009 焦虑 79.38±16.32 72.38±16.81 1.167 0.255
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[1] 李建成, 杨东昆, 宋培军, 等. 游离皮瓣移植在全舌切除后Ⅰ期修复重建中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 736-742. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202008014.htm
[2] Yao C, Hutcheson KA. Quality of Life Implications After Transoral Robotic Surgery for Oropharyngeal Cancers[J]. Otolaryngol Clin North Am, 2020, 53(6): 1117-1129. doi: 10.1016/j.otc.2020.07.018
[3] 李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果[J]. 南方医科大学学报, 2020, 40(6): 814-821. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD202006008.htm
[4] Caudell JJ, Torres-Roca JF, Gillies RJ, et al. The future of personalised radiotherapy for head and neck cancer[J]. Lancet Oncol, 2017, 18(5): e266-e273. doi: 10.1016/S1470-2045(17)30252-8
[5] Tirelli G, Boscolo Nata F, Piovesana M, et al. Transoral surgery(TOS)in oropharyngeal cancer: Different tools, a single mini-invasive philosophy[J]. Surg Oncol, 2018, 27(4): 643-649. doi: 10.1016/j.suronc.2018.08.003
[6] Liu L, Chen J, Cai X, et al. Progress in targeted therapeutic drugs for oral squamous cell carcinoma[J]. Surg Oncol, 2019, 31: 90-97. doi: 10.1016/j.suronc.2019.09.001
[7] 许操, 李建成, 宋培军, 等. 腓动脉穿支双叶皮瓣在舌癌、口底癌术后缺损修复中的应用[J]. 中华整形外科杂志, 2020, 36(8): 893-898. doi: 10.3760/cma.j.cn114453-20191224-00383
[8] Burusapat C. Perforator Flap Reconstruction for the Distal Third of Lower Extremity Defects: Clinical Application and Guideline Recommendation[J]. Int J Low Extrem Wounds, 2019, 18(4): 376-388. doi: 10.1177/1534734619861018
[9] Liu K, Zhang W, Wang Y, et al. Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report[J]. Medicine(Baltimore), 2020, 99(50): e23590.
[10] Li J, Song P, Yang D, et al. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report[J]. Br J Oral Maxillofac Surg, 2020, 58(3): 355-357. doi: 10.1016/j.bjoms.2019.10.318
[11] Gervès-Pinquié C, Daumas-Yatim F, Lalloué B, et al. Impacts of a navigation program based on health information technology for patients receiving oral anticancer therapy: the CAPRI randomized controlled trial[J]. BMC Health Serv Res, 2017, 17(1): 133. doi: 10.1186/s12913-017-2066-x
[12] Li C, Cai Y, Wang W, et al. Combined application of virtual surgery and 3D printing technology in postoperative reconstruction of head and neck cancers[J]. BMC Surg, 2019, 19(1): 182. doi: 10.1186/s12893-019-0616-3
[13] Du YF, Chen N, Li DQ. [Application of robot-assisted surgery in the surgical treatment of head and neck cancer][J]. Zhonghua Kou Qiang Yi Xue Za Zhi, 2019, 54(1): 58-61.
[14] 徐凯, 蔡兰军, 陈红, 等. 经口机器人手术治疗口咽癌的安全性及有效性的初步探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(2): 109-115. doi: 10.3760/cma.j.issn.1673-0860.2020.02.006
[15] Moeckelmann N, Ebrahimi A, Tou YK, et al. Prognostic implications of the 8th edition American Joint Committee on Cancer(AJCC)staging system in oral cavity squamous cell carcinoma[J]. Oral Oncol, 2018, 85: 82-86. doi: 10.1016/j.oraloncology.2018.08.013
[16] Colevas AD, Yom SS, Pfister DG, et al. NCCN Guidelines Insights: Head and Neck Cancers, Version 1.2018[J]. J Natl Compr Canc Netw, 2018, 16(5): 479-490. doi: 10.6004/jnccn.2018.0026
[17] Xu S, Sagiv O, Rubin ML, et al. Validation Study of the AJCC Cancer Staging Manual, Eighth Edition, Staging System for Eyelid and Periocular Squamous Cell Carcinoma[J]. JAMA Ophthalmol, 2019, 137(5): 537-542. doi: 10.1001/jamaophthalmol.2019.0238
[18] 孙黎波, 兰玉燕, 周航宇, 等. 基于数字化技术的游离腓骨肌皮瓣在下颌骨缺损中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(7): 626-629. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202007013.htm
[19] 李建成, 宋培军, 杨东昆, 等. 小腿后外侧腓动脉双叶穿支游离皮瓣修复口腔颌面部恶性肿瘤术后面部洞穿性缺损[J]. 中华显微外科杂志, 2019, 42(1): 26-31. doi: 10.3760/cma.j.issn.1001-2036.2019.01.008
[20] 马治超, 孙黎波, 周航宇, 等. 折叠游离前臂皮瓣修复颊癌术后洞穿性缺损的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(13): 1002-1005. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201813010.htm
[21] Rogers SN, Lowe D. Health-related quality of life after oral cancer treatment: 10-year outcomes[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2020, 130(2): 144-149. doi: 10.1016/j.oooo.2020.02.018
[22] Wang S, Yin S, Zhang ZL, et al. Quality of Life After Oral Cancer Resection and Free Flap Reconstruction[J]. J Oral Maxillofac Surg, 2019, 77(8): 1724-1732. doi: 10.1016/j.joms.2019.02.029
[23] Yue J, Zhuo S, Zhang H, et al. Long-term quality of life measured by the University of Washington QoL questionnaire(version 4) in patients with oral cancer treated with or without reconstruction with a microvascular free flap[J]. Br J Oral Maxillofac Surg, 2018, 56(6): 475-481. doi: 10.1016/j.bjoms.2017.12.017
[24] Huang SH, Hahn E, Chiosea SI, et al. The role of adjuvant(chemo-)radiotherapy in oral cancers in the contemporary era[J]. Oral Oncol, 2020, 102: 104563. doi: 10.1016/j.oraloncology.2019.104563
[25] Liu J, Yang X, Zhang S, et al. 中国口咽癌的发病率、死亡率和时间格局: 一项基于人群的研究[J]. 癌症, 2019, 38(6): 272-281. https://www.cnki.com.cn/Article/CJFDTOTAL-AIZH201906003.htm
[26] Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2019[J]. CA Cancer J Clin, 2019, 69(5): 363-385. doi: 10.3322/caac.21565
[27] 周维, 何明艳, 沈婉莹, 等. 2005~2015年中国口腔癌发病及死亡趋势分析[J]. 华中科技大学学报(医学版), 2020, 49(6): 706-711. doi: 10.3870/j.issn.1672-0741.2020.06.010
[28] 肖水芳, 赵欣, 张俊波, 等. 等离子射频技术辅助经口微创手术治疗口咽及口腔恶性肿瘤的临床观察[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(22): 1705-1710. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201722001.htm
[29] Kubik MW, Sridharan S, Varvares MA, et al. Intraoperative Margin Assessment in Head and Neck Cancer: A Case of Misuse and Abuse?[J]. Head Neck Pathol, 2020, 14(2): 291-302. doi: 10.1007/s12105-019-01121-2
[30] Hess AS, Hess JR. Kaplan-Meier survival curves[J]. Transfusion, 2020, 60(4): 670-672. doi: 10.1111/trf.15725
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