頁籤選單縮合
題 名 | 扁桃腺癌手術治療之長期經驗=Long Term Results of Surgery for Tonsillar Carcinoma |
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作 者 | 戴世光; 張學逸; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷 期 | 34:6 民88.11-12 |
頁 次 | 頁441-447 |
分類號 | 416.894 |
關鍵詞 | 扁桃腺癌; Tonsillar carcinoma; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:扁桃腺癌多數患者於診斷時已為晚期病患,由於鄰近解剖構造較複雜,徹底切除病灶及其術後功能重建頗具挑戰性。我們回顧42例扁桃腺癌接受手術治療之病患,報告各種切除及重建方法的長期經驗。方法:自1980年9月到1996年11月,共收集42例扁桃腺鱗狀上皮癌手術病患,分別以經口切除(transoral)、經下頜骨切開(mandibulotomy)、下頜骨邊緣切除(marginal mandibulectomy)或下頜骨部分切除(segmental mandibulectomy)等方式,徹底切除腫瘤,同時也施行頸部廓清術。術後則視需要以各種肌皮瓣或肌肉瓣,重建口咽缺損。結果:42例手術病患中有34例施行下頜骨部分切除,3例下頜骨邊緣切除,3例下頜骨切開侑2例經口切除。口咽缺損之重建方面,以嚼肌肌肉瓣(masseter muscle flap)的使用為最多。經病理報告證實已經有頸部轉移者有21例(50%)。在術後機能方面有6例(14.3%)必須以鼻胃管或胃造口灌食,其餘都恢復由口進食。術後併發症方面,以下頜胃胃髓炎及傷口感染最常見。局部復發有9例,其中6例為T2,復發部位主要發生於舌根及扁桃體窩(fossa)。結論:扁桃腺癌之手術必須掌握鄰近頸動靜脈血管之側咽解剖位置,才能達到徹底的目標,下頜胃部分切除有助於較大病灶之徹底切除。局部復發也常會發生在早期病例,因此對於早期病例的手術治療不宜過度保守。早期診斷是降低遠處轉移並提高存活率的重要關鍵。 |
英文摘要 | BACKGROUND: Many patients with tonsillar carcinoma present with advanced disease. Radical excision of a tonsillar tumor is challenging because of the complex anatomical structures nearby. A retrospective analysis of surgical treatment for 42 patients with tonsillar carcinoma was undertaken. METHODS: From Sep 1980 to Now 1996, 42 patients with tonsillar carcinoma were surgically treated with curative intent. The surgical approach included a transoral or mandibulotomy approach, or combined with a marginal or segmental mandibulectomy. Ipsilateral neck dissection was done in most cases. Myocutneous or muscle flaps were utilized for the reconstruction procedure. RESULTS: Thirty-four patients underwent segmental mandibulecotmy, three had a marginal mandibulectomy, three had a mandibulotomy and two had a transoral approach. Twenty-one cases underwent masseter muscle flap reconstruction. Cervical metastasis was proved pathologically in twenty-one cases (50%). Six patients eventually depended on nasogastric tube or gastrostomy feedings. The major postoperative complication were mandibular osteomyelitis and wound infection. There was local recurrence in nini cases, and six of them were T2, most frequently at the base of the tongue. The five-year disease free survival rate was 62.7%. CONCLUSIONS: Proper identification of the internal carotid artery and segmental Resection of the mandible makes radical excision of tonsillar carcinoma easier. Local recurrence is not rare in early cases, mostly resulting from a conservative excision policy. Early diagnosis assures a lower incidence of distant metastasis and a higher survival rate. |
本系統中英文摘要資訊取自各篇刊載內容。