对晚期舌底癌的手术治疗有自己的经验

P. Svetitskiy, I. V. Pustovaya, M. Engibaryan, M. V. Bauzhadze, A. Donskaya
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摘要

研究目的:改善晚期舌和口底癌患者的手术治疗效果,提供保留器官功能的根治性手术。材料和方法。临床2组2例晚期舌底癌伴颈部淋巴结转移患者(St.4 (IVA, t4a - N2b - M0)),采用特殊术式行手术治疗。手术在气管内麻醉下进行。颈部淋巴结清扫后,经口内切除舌及口底组织。切口沿着健康组织的整个厚度切开。从解剖组织中取涂片用于术中病理咨询,以检查是否存在癌细胞。受肿瘤影响的口底组织被完全切除了,没有超出舌骨舌肌,因为舌神经和舌下神经沿着它的外表面。这使得肿瘤根治性切除并保留了舌头的功能。术后观察9个月以上,肿瘤未继续生长,肿瘤复发,舌部及口底功能完好。在这类患者中,整形原则与保留舌头功能相结合。这是可以实现的,因为在切除舌肿瘤后,切除口底时不会超出未受肿瘤影响的舌骨舌肌,因为舌神经和舌下神经沿着舌骨舌肌的外表面。与塑料一样,它保留了舌头的功能:咀嚼,吞咽,清晰的语言,味觉感知。
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Own experience of surgical treatment for advanced cancer of the tongue and the mouth floor
Purpose of the study. Improvement of surgical treatment outcomes in patients with advanced cancer of the tongue and the mouth floor providing radical surgery with preservation of the organ functions.Materials and methods. Two patients with advanced cancer of the tongue and the mouth floor with metastases to lymph nodes in the neck (St.4 (IVA, рT4a N2b M0), clinical group 2, were operated on according to our special technique. The surgery was performed under endotracheal anesthesia. After cervical lymph node dissection, the tongue and the mouth floor tissues were resected intraorally. The incisions were made through their entire thickness along healthy tissues. Smears were taken from the dissected tissues for intraoperative pathology consultation control for the presence of cancer cells. The tissues of the mouth floor affected by the tumor were completely removed without going beyond the hyoglossus muscle, since the lingual and hypoglossal nerves go along its outer surface. This allowed radical tumor removal with preservation of the tongue functions.Results. Patients operated on according to our special technique have been observed for more than 9 months without continued tumor growth and recurrences tumor with preservation of the tongue and the mouth floor functions.Conclusion. In such patients, ablastics principles are combined with the preservation of the tongue functions. This can be achieved because after removal of the tongue tumor, resection of the mouth floor is performed without going beyond the hyoglossus muscle not affected by the tumor, since the lingual and hypoglossal nerves go along its outer surface. Complying with ablastics, it preserves the tongue functions: chewing, swallowing, articulate speech, taste perception.
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