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.
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。.
Keywords: free skin flap; minimal surgical procedures; mouth neoplasms; oropharyngeal neoplasms; quality of life.
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