Current concepts in management of oral cancer--surgery.
Current concepts in management of oral cancer--surgery.
复制标题
口腔癌治疗的当前概念——手术。
DOI：
10.1016/j.oraloncology.2008.05.017
复制
发表时间：
2009-04
期刊：
影响因子：
4.8
通讯作者：
Gil, Ziv
中科院分区：
文献类型：
--
作者：
Shah, Jatin P.;Gil, Ziv
关键词：
口腔癌是全球第六大常见癌症，在南亚发病率很高。吸烟和饮酒仍然是最主要的致病因素，但HPV最近与口腔癌有关。手术是大多数口腔癌最完善的初始确定性治疗模式。影响治疗选择的因素与肿瘤和患者有关。原发部位、位置、大小、与骨的接近程度和浸润深度是影响特定手术入路的因素。肿瘤的方法或涉及下颌骨需要具体的了解骨受累的机制。这有利于采用下颌骨保留方法，如下颌骨边缘切除术和下颌骨切开术。口腔内主要的外科缺损的重建需要使用游离皮瓣。前臂桡侧游离皮瓣为口腔软组织缺损提供了良好的软组织和衬里。游离腓骨瓣仍是下颌骨重建的首选。在过去的三十年中，口腔癌患者的总体生存率有所提高，这主要是由于对局部进展的生物学理解的提高，颈部转移淋巴结的早期识别和治疗，以及术后辅助放疗和放化疗的应用。手术在头颈部其他部位原发性鳞状细胞癌中的作用随着顺序或同时采用化疗和放疗的多学科治疗方法的整合而发展。因此，喉保留与同步放化疗已成为护理标准的局部晚期喉癌或咽需要全喉切除术。另一方面，对于喉和咽部的早期肿瘤，经口激光显微手术已成为局部控制这些病变的有效手段。颅底外科的进步显著提高了副鼻窦恶性肿瘤接近或累及颅底患者的生存率。因此，手术仍然是治疗头颈部大部分肿瘤的主要手段。同样，在头颈部恶性肿瘤患者的整个生命史中，从最初诊断到最终治疗、治疗后监测、并发症管理、治疗后遗症康复，以及最终缓解症状，外科医生的作用至关重要。
Oral cancer is the sixth most common cancer worldwide, with a high prevalence in South Asia. Tobacco and alcohol consumption remain the most dominant etiologic factors, however HPV has been recently implicated in oral cancer. Surgery is the most well established mode of initial definitive treatment for a majority of oral cancers. The factors that affect choice of treatment are related to the tumor and the patient. Primary site, location, size, proximity to bone, and depth of infiltration are factors which influence a particular surgical approach. Tumors that approach or involve the mandible require specific understanding of the mechanism of bone involvement. This facilitates the employment of mandible sparing approaches such as marginal mandibulectomy and mandibulotomy. Reconstruction of major surgical defects in the oral cavity requires use of a free flap. The radial forearm free flap provides excellent soft tissue and lining for soft tissue defects in the oral cavity. The fibula free flap remains the choice for mandibular reconstruction. Over the course of the past thirty years there has been improvement in the overall survival of patients with oral carcinoma largely due to the improved understanding of the biology of local progression, early identification and treatment of metastatic lymph nodes in the neck, and employment of adjuvant postoperative radiotherapy and chemoradiotherapy. The role of surgery in primary squamous cell carcinomas in other sites in the head and neck has evolved with integration of multidisciplinary treatment approaches employing chemotherapy and radiotherapy either sequentially or concurrently. Thus, larynx preservation with concurrent chemoradiotherapy has become the standard of care for locally advanced carcinomas of the larynx or pharynx requiring total laryngectomy. On the other hand, for early staged tumors of the larynx and pharynx, transoral laser microsurgery has become an effective means of local control of these lesions. Advances in skull base surgery have significantly improved the survivorship of patients with malignant tumors of the paranasal sinuses approaching or involving the skull base. Surgery thus remains the mainstay of management of a majority of neoplasms arising in the head and neck area. Similarly, the role of the surgeon is essential throughout the life history of a patient with a malignant neoplasm in the head and neck area, from initial diagnosis through definitive treatment, post-treatment surveillance, management of complications, rehabilitation of the sequelae of treatment, and finally for palliation of symptoms.
登录
查看更多内容
影响因子：
1.4
作者：
Ambrosch, P;Kron, M;Steiner, W
通讯作者：
Steiner, W
影响因子：
158.5
作者：
WOLF, GT
通讯作者：
WOLF, GT
影响因子：
3
作者：
SPIRO, RH;GEROLD, FP;STRONG, EW
通讯作者：
STRONG, EW
DOI：
10.1016/j.bjoms.2005.07.018
发表时间：
2006-10-01
影响因子：
1.8
作者：
Brown, J. S.;Magennis, P.;Vaughan, E. D.
通讯作者：
Vaughan, E. D.
影响因子：
3.4
作者：
Steiner, W;Ambrosch, P;Kron, M
通讯作者：
Kron, M