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山东大学学报(医学版) ›› 2015, Vol. 53 ›› Issue (8): 79-82.doi: 10.6040/j.issn.1671-7554.0.2014.1009

• 临床医学 • 上一篇    下一篇

不同下颌骨截骨方式在咽相关区域肿瘤手术中的应用

黄乃邦1,2, 达鹏1, 卢军3, 吴昊1   

  1. 1. 南通大学附属医院耳鼻咽喉头颈外科, 江苏 南通 226001;
    2. 盐城市第一人民医院耳鼻咽喉头颈外科, 江苏 盐城 224000;
    3. 南通大学附属医院口腔颌面外科, 江苏 南通 226001
  • 收稿日期:2014-12-29 发布日期:2015-08-10
  • 通讯作者: 吴昊.E-mail:entwuhao@163.com E-mail:entwuhao@163.com
  • 基金资助:
    江苏省博士后基金(1302082C);南通大学附属医院博士后基金(128385)

Applications of different mandibulotomy approaches to the resection of pharyngeal region tumors

HUANG Naibang1,2, DA Peng1, LU Jun3, WU Hao1   

  1. 1. Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China;
    2. Department of Otolaryngology Head and Neck Surgery, Yancheng City No.1 People's Hospital, Yancheng 224000, Jiangsu, China;
    3. Department of Stomatology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
  • Received:2014-12-29 Published:2015-08-10

摘要: 目的 探讨不同下颌骨截骨方式在咽相关区域暴露及肿瘤切除手术中的适应证.方法 回顾性分析2006年1月至2013年12月采用下颌骨截骨方式切除咽相关解剖区域肿瘤23例,其中应用下颌骨正中截开7例,下颌骨角部截开6 例,单纯下颌骨方块或“L”型截骨5例,下颌骨升支纵行截开5例.结果 运用4种下颌骨截骨方式,术野暴露满意,均完整切除肿瘤,恶性肿瘤切缘均为阴性;12例患者术后给予放疗或同步放化疗,均未出现放射性骨髓炎.所有患者术后下颌功能恢复良好,张口度及咬合达到理想要求.结论 咽相关区域复杂肿瘤手术时根据肿瘤原发位置、性质及大小,灵活机动地采取不同的下颌骨截骨方式,不仅可以获得良好的术野和肿瘤切除的安全界限,也可以较好地满足一期修复及口颌系统功能恢复的要求.

关键词: 外科手术, 肿瘤, 咽, 下颌骨

Abstract: Objective To discuss the indications of different mandibulotomy approaches for the exposure and resection of tumors in the pharyngeal region. Methods A retrospective analysis was presented for 23 resection of pharyngeal region tumors between January 2006 and December 2013. The mandibulotomy included the middle of the corpus mandibulae osteotomy (7 cases), the angulus mandibulae osteotomy (6 cases), pure block or “L” shape corpus mandibulae osteotomy (5 cases), and through vertical corpus mandibulae osteotomy (5 cases). Results The operation visual fields were sufficient. The operations were completed smoothly and successfully.The cutting edge of malignant tumors were all negative. Twelve patients were treated with postoperative radiotherapy or radiotherapy companied by chemotherapy, and radioactive osteomyelitis did not occur. All patients' mandibular function recovered well and the degree of mouth opening and occlusion met the ideal requirements. Conclusion Different mandibulotomy approach should be chosen according to the primary tumor location, nature, and size. To take different approaches flexibly can not only acquire a good operative field but also meet the demand of one stage repairment and recovery of stomatognathic system function.

Key words: Mandible, Pharyngea, Surgery, Neoplasm

中图分类号: 

  • R739.9
[1] Kuet ML, Kasbekar AV, Masterson L, et al. Management of tumors arising from the Parapharyngeal space: a systematic review of 1293 cases reported over 25 years[J]. Laryngoscope, 2015, 125(6): 1372-1381.
[2] 达林泰,德乐黑巴特尔,苏尼特,等.咽旁间隙巨大肿瘤的手术径路探讨[J].口腔颌面外科杂志, 2013, 23(2):123-127. DA Lintai, DE Leleibateer, SU Nite, et al. Surgical approaches to resection of bulky tumors in parapharyngeal space[J]. Journal of Oral and Maxillofacial Surgery, 2013, 23(2):123-127.
[3] 殷蔚伯,余子豪,徐国镇.肿瘤放射治疗学[M].北京:中国协和医科大学出版社, 2008:357-361.
[4] 屠规益.现代头颈肿瘤外科学[M]. 北京:科学出版社, 2004:40, 58.
[5] Dziegielewski PT, O'Connell DA, Rieger J, et al. The lip-splitting mandibulotomy: aesthetic and functional outcomes[J]. Oral Oncology, 2010, 46(8):612-617.
[6] 裘松波,张纲,王建华,等.保留牙列和下颌骨行舌癌根治术的近期疗效观察[J].口腔颌面外科杂志, 2009, 19(6):1005-1009. QIU Songbo, ZHANG Gang, WANG Jianhua, et al. Short term results in radical dissection for tongue carcinoma with preservation of the integrity of mandible and dentition[J]. Jornal of Oral and Maxllofaal Rgry, 2009, 19(6):1005-1009.
[7] 黄罡,卢利,刘影.下颌骨旁正中劈开入路在治疗腮腺深叶巨大肿瘤中的应用[J].实用口腔医学杂志, 2011, 27(4):565-567. HUANG Gang, LU Li, LIU Ying. The treatment of large tumor in parotid deep lobe by paramedian mandibulotomy approach[J]. Pract Stomatol, 2011, 27(4):565-567.
[8] Na HY, Choi EJ, Choi EC, et al. Modified mandibulotomy technique to reduce postoperative complications: 5-year results[J]. Yonsei Med J, 2013, 54(5):1248-1252.
[9] Vikatmaa P, Mäkitie AA, Railo M, et al. Midline mandibulotomy and interposition grafting for lesions involving the internal carotid artery below the skull base[J]. J Vasc Surg, 2009, 49(1):86-92.
[10] Presutti L, Molteni G, Malvè L, et al. Parapharyngeal space tumors without mandibulotomy: our experience[J]. Eur Arch Otorhinolaryngol, 2012, 269(1):265-273.
[11] 桑建中,娄卫华,张亚民.咽旁间隙肿瘤的诊断及手术入路选择[J].临床耳鼻喉头颈外科杂志, 2011, 25(21):961-965. SANG Jianzhong, LOU Weihua, ZHANG Yamin. Diagnosis and operation approach of tumors in the parapharyngeal space[J]. J Clin Otorhinolaryngol Head Neck Surg, 2011, 25(21):961-965.
[12] Ansarin M, Tagliabue M, Chu F, et al. Transoral robotic surgery in retrostyloid parapharyngeal space schwannomas[J]. Case Rep Otolaryngol, 2014:296025. doi: 10.1155/2014/296025.
[13] 张华,冯永,蒋璐.经口径路咽旁间隙巨大肿瘤切除术(附6例报道)[J].临床耳鼻咽喉头颈外科杂志, 2010, 24(12):556-558. ZHANG Hua, FENG Yong, JIANG Lu. Tumorectomy by trans-oral approach of macrosis benign neoplasms in parapharyngeal space (reports of 6 cases)[J]. J Clin Otorhinolaryngol Head Neck Surg, 2010, 24(12):556-558.
[14] 卢军,冯兴梅,徐克,等.聚左旋丙交酯可吸收材料在下颌骨骨折中的临床应用[J].中国现代医学杂志, 2011, 21(32):4091-4096. LU Jun, FENG Xingmei, XU Ke, et al. Clinical application of degradation Poly (L/Lactide) in fracture of mandible[J]. China Journal of Modern Medicine, 2011, 21(32):4091-4096.
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