中国癌症杂志 ›› 2013, Vol. 23 ›› Issue (12): 937-941.doi: 10.3969/j.issn.1007-3969.2013.12.001

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舌癌的间室外科

张陈平   

  1. 上海交通大学医学院附属第九人民医院口腔颌面- 头颈肿瘤科,上海 200011
  • 出版日期:2013-12-30 发布日期:2014-02-17
  • 通信作者: 张陈平 E-mail:zhang.chenping@hotmail.com

Compartmental tongue surgery

ZHANG Chen-ping   

  1. Department of Oral & Maxillofacial – Head & Neck Oncology, Ninth People’s Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
  • Published:2013-12-30 Online:2014-02-17
  • Contact: ZHANG Chen-ping E-mail: zhang.chenping@hotmail.com

摘要: 尽管多学科肿瘤综合序列治疗已逐渐应用于临床,但口腔癌的5年总生存率维持在45%~50%。回顾性研究显示,目前临床病理学特征很难确定肿瘤预后、复发率和生存率。然而,能否进行根治性切除并获取安全切缘则是影响口腔癌局部控制的最重要的因素。舌体分别由舌内肌和舌外肌组成。肌束走向及其密集分布的神经血管束使舌比其他口腔组织利于肿瘤向深层侵袭。舌癌浸润生长方式是沿着肌束方向或者神经血管束间隙前进的。单纯传统的距肿瘤边缘1~2 cm扩大切除未能切除深面肌束。舌癌切除需参照解剖间室切除原则,这使得原发肿瘤和颈部淋巴结构之间潜在的侵袭途径可以被完整的切除,达成更彻底的根治目标, 可以提高局控率。相比之下,舌淋巴系统与其余口腔癌淋巴回流有差异,即使en-bloc切除也未见将其舌淋巴结包涵在内,唯独间室切除可将舌淋巴结暴露于手术野内并完整切除。间室切除作为舌癌原发灶外科根治的一种术式,已经初步展现其科学性和可行性,同时也证实了局控率的改善。因此,今后需要共同探索口腔癌的发生发展规律和肿瘤浸润转移特点,寻求不同部位口腔癌间室切除的规范模式,增强口腔癌外科治疗的根治力度,努力提高患者的生存率。

关键词: 口腔癌, 舌癌, 间室外科, 生存率

Abstract: Despite the evolution in cancer management and the introduction of multidisciplinary treatment modalities, 5-year overall survival rate of oral cancer remained to be 45-50%. Retrospectively, one patient's prognosis, relapse pattern and survival were determined by clinicopathological parameters. Nevertheless, radical resection with adequate safe margins is crucial for local control in treatment strategy for oral cancer. However, orthogonally muscle orientation of tongue with enriched neurovascular bundles and lymphatic network make it disadvantaged for progressive deep tumor invasion and regional metastasis. Tumor spread along the muscle fibers following the path of least resistance, this thereby reflected the shortcomings of conventional 1-2cm circumferential wide excision. Compartment resection is removal of entire primary lesion along with its entire potential spreading path with an advantage in removing the potential spreading path. Contrary, lymphatic drainage of tongue cancer is outstanding, there is overtly existence of lymphatic vessels and lingual lymph node which occult lymph node metastasis might easily being overshadowed. Routine neck dissection is disadvantaged for unable to reach. Nevertheless, compartmental surgery can overcome it by bringing lingual lymphatic system into surgical field. Compartment resection is more appreciable than conventional 1-2cm wide resection in fulfilling oncological radicality criteria. In summary, we need to explore the characteristic pattern of tumor invasion and metastasis for other subtypes of oral cancer, thereby establishing a location orientated compartment resection, subsequently enhance the radicality of surgical management and strive to improve the survival rate.

Key words: Oral cancer, Tongue cancer, Compartment surgery, Survival rate