晚期舌癌全舌切除的手术治疗：62例临床分析

doi:10.19438/j.cjoms.2026.02.006

摘要/Abstract

摘要： 目的: 回顾需全舌切除的晚期舌癌患者的手术资料及相关预后数据,为该类患者的手术决策与优化提供参考。方法: 收集2013年1月—2024年12月南京大学医学院附属口腔医院收治的62例晚期舌癌全舌切除患者的临床资料,根据手术方式分为两组—A组（40例）行病灶切除+颈淋巴清扫,B组（22例）行En bloc切除（颈部大块组织与舌癌病灶整体切除）。采用Kaplan-Meier法分析生存率,Cox比例风险回归模型分析复发、转移的影响因素。结果: A组复发、转移率为17.50%（7/40）,3年生存率为75.00%;B组复发、转移率为22.73%（5/22）,3年生存率为68.18%。Cox回归分析显示,术式选择与术后复发转移无显著关联（P=0.537）;两组生存曲线无统计学差异（P=0.505）。亚组分析显示,无论淋巴结状态为pN0-pN1（P=0.879）还是 pN2-pN3（P=0.523）,两组生存率均无显著差异。淋巴结状态（pN2-pN3∶pN0-pN1,HR=4.193,P=0.02）及淋巴结包膜外侵犯（ENE阳性,HR=4.158,P=0.016）是术后复发、转移的独立危险因素。结论: 晚期舌癌患者生存率较低,手术需根据颈淋巴结及肿瘤侵犯情况进行综合考虑。对于术前临床检查或影像学未提示有颈淋巴结转移或肿瘤突入下颌下间隙的患者,可考虑选择“病灶切除+颈淋巴清扫”若已有淋巴结转移或肿瘤已突入下颌下间隙,则应行En bloc切除,术中均应重视口底区域的处理。术中形成的软组织缺损,应综合多种因素选择合适的修复方式。

关键词: 晚期舌癌, En bloc切除, 颈淋巴清扫术, 全舌切除, 皮瓣修复

Abstract: PURPOSE: To review the surgical data and related prognostic data of patients with advanced tongue cancer requiring total glossectomy, and to provide a reference for surgical decision-making and optimization in such patients. METHODS: Clinical data of 62 patients with advanced tongue cancer who underwent total glossectomy in Affiliated Hospital of Medical School, Nanjing University from January 2013 to December 2024 were collected. The patients were divided into two groups according to the surgical methods: group A(n=40) underwent lesion resection + neck dissection, and group B (n=22) underwent En bloc resection (En bloc removal of large cervical tissue and tongue cancer lesions). Kaplan-Meier method was used to analyze the survival rate, and Cox proportional hazards regression model was used to analyze the influencing factors of recurrence and metastasis. RESULTS: The recurrence and metastasis rate of group A was 17.50%(7/40), with a 3-year survival rate of 75.00%; the recurrence and metastasis rate of group B was 22.73% (5/22), with a 3-year survival rate of 68.18%. Cox regression analysis showed that there was no significant correlation between surgical method selection and postoperative recurrence and metastasis (P=0.537). There was no significant difference in the survival curves between the two groups (P=0.505). Subgroup analysis showed that there was no significant difference in survival rate between the two groups regardless of lymph node status(pN0-pN1, P=0.879; pN2-pN3, P=0.523). Lymph node status (pN2-pN3 vs pN0-pN1, HR=4.193, P=0.02) and extranodal extension(ENE positive, HR=4.158, P=0.016) were independent risk factors for postoperative recurrence and metastasis. CONCLUSIONS: The survival rate of patients with advanced tongue cancer is relatively low, and surgical plans should be comprehensively considered based on cervical lymph node status and tumor invasion. For patients with no preoperative clinical examination or imaging evidence of cervical lymph node metastasis or tumor protrusion into the submandibular space, "lesion resection + neck dissection" can be considered. If lymph node metastasis has occurred or the tumor has protruded into the submandibular space, En bloc resection should be performed, and attention should be paid to the management of the floor of mouth during operation. For soft tissue defects formed during operation, an appropriate repair method should be selected based on comprehensive consideration of multiple factors.

Key words: Advanced tongue cancer, En bloc resection, Neck dissection, Total glossectomy, Flap repair

中图分类号:

R739.8

许慧霞, 寇家豪, 李馥焰, 江晨曦, 曹婷, 孙国文. 晚期舌癌全舌切除的手术治疗：62例临床分析[J]. 中国口腔颌面外科杂志, 2026, 24(2): 133-138.

Xu Huixia, Kou Jiahao, Li Fuyan, Jiang Chenxi, Cao Ting, Sun Guowen. Surgical treatment of total glossectomy for advanced tongue cancer: a clinical analysis of 62 cases[J]. China J Oral Maxillofac Surg, 2026, 24(2): 133-138.

参考文献

[1] Matsuo K, Akiba J, Kusukawa J, et al.Squamous cell carcinoma of the tongue: subtypes and morphological features affecting prognosis[J]. Am J Physiol Cell Physiol, 2022, 323(6): C1611-C1623.
[2] AlMadan NM, AlHamidi A, AlMalki B, et al. Prognostic risk factors of oral squamous cell carcinoma: a retrospective case-control study at a tertiary hospital in Riyadh, Saudi Arabia[J]. Cureus, 2025, 17(5): e84213.
[3] López-Cedrún JL, Andrés de Llano J. A 22 years survival and prognostic factors analysis in a homogeneous series of 64 patients with advanced cancer of the tongue and the floor of the mouth[J]. J Craniomaxillofac Surg, 2015, 43(3): 376-381.
[4] Han W, Wang Y, Li T, et al.A CT-based integrated model for preoperative prediction of occult lymph node metastasis in early tongue cancer[J]. PeerJ, 2024, 12: e17254.
[5] 贾俊,赵怡芳. 舌、口底癌的连续性与非连续性颈淋巴清扫术[J]. 口腔颌面外科杂志, 2021, 31(3): 131-136.
Jia J, Zhao YF.Discontinuous versus in-continuity neck dissection of squamous cell carcinoma of tongue and floor of the mouth[J]. Journal of Oral and Maxillofacial Surgery, 2021, 31(3): 131-136.
[6] Wang HC, Zheng Y, Pang P, et al.Discontinuous versus in-continuity neck dissection in squamous cell carcinoma of the tongue and floor of the mouth: comparing the rates of locoregional recurrence[J]. J Oral Maxillofac Surg, 2018, 76(5): 1123-1132.
[7] Tagliabue M, Gandini S, Maffini F, et al.The role of the T-N tract in advanced stage tongue cancer[J]. Head Neck, 2019, 41(8): 2756-2767.
[8] Calabrese L, Tagliabue M, Grammatica A, et al.Compartmental tongue surgery for intermediate-advanced squamous cell carcinoma: a multicentric study[J]. Head Neck, 2023, 45(11): 2862-2873.
[9] Calabrese L, Bruschini R, Giugliano G, et al.Compartmental tongue surgery: long term oncologic results in the treatment of tongue cancer[J]. Oral Oncol, 2011, 47(3): 174-179.
[10] Tesseroli MA, Calabrese L, Carvalho AL, et al.Discontinuous vs. in-continuity neck dissection in carcinoma of the oral cavity. experience of two oncologic hospitals[J]. Acta Otorhinolaryngol Ital, 2006, 26(6): 350-355.
[11] 张晶,张诠,曾宗渊,等. 口底鳞癌非连续性与连续性颈淋巴结清除疗效的比较分析[J]. 中华肿瘤防治杂志, 2008, 15(8): 621-623, 638.
Zhang J, Zhang Q, Zeng ZY, et al.Curative effect of non-continuous and continuous neck dissection in squamous cell carcinoma of the floor of mouth[J]. Chinese Journal of Cancer Prevention and Treatment, 2008, 15(8): 621-623, 638.
[12] Ghosh R, Pandey S, Sinha B, et al.Lingual lymph nodes in tongue cancers: a systematic review and meta-analysis[J]. Br J Oral Maxillofac Surg, 2025, 63(8): 554-561.
[13] 张孟殷,严文洪. 口底区域淋巴组织清扫术在舌癌根治术中的应用评述[J]. 中国口腔颌面外科杂志, 2005, 3(1): 40-41.
Zhang MY, Yan WH.Application review of submental regional lymphoid tissue dissection in radical resection of tongue cancer[J]. China Journal of Oral and Maxillofacial Surgery, 2005, 3(1): 40-41.
[14] 胡永杰,曲行舟,徐立群,等. 口底区域淋巴组织清扫术在舌癌根治术中的应用[J]. 中国口腔颌面外科杂志, 2005, 3(1): 29-33.
Hu YJ, Qu XZ, Xu LQ, et al.Management of the floor of mouth in tongue cancer patients: a clinical study of rational surgical pattern[J]. China Journal of Oral and Maxillofacial Surgery, 2005, 3(1): 29-33.
[15] Calabrese L, Renne G, De Cicco C, et al.Metastatic cancer to the floor of mouth: the lingual lymph nodes[J]. Head Neck, 2003, 25(4): 341-342.
[16] Wu K, Zhang S, Wu HJ.A precise glossectomy for tongue cancer adjacent to or crossing the midline: a novel anatomical unit resection surgery[J]. Int J Oral Maxillofac Surg, 2023, 52(7): 725-734.
[17] 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): 412-414.
Qiu SB, Zhang G, Wang JH, et al.Short term results in radical dissection for tongue carcinoma with preservation of the integrity of mandible and dentition[J]. Journal of Oral and Maxillofacial Surgery,2009, 19(6): 412-414.
[18] 廖贵清,唐海阔,黄洪章. 保持下颌骨完整性改良联合根治术在中晚期舌癌治疗中的应用[J]. 实用口腔医学杂志, 2006, 22(1): 8-10.
Liao GQ, Hai HK, Huang HZ.Modified combined radical neck dissection remaining integrality of mandible for the treatment of advanced tongue squamous cell carcinoma[J]. Journal of Practical Stomatology, 2006, 22(1): 8-10.
[19] Lee G, Chang YJ, Park J, et al.Free vertical latissimus dorsi flap for tongue reconstruction after total glossectomy[J]. In Vivo, 2023, 37(6): 2710-2718.
[20] Thompson JA, Vakharia KT, Hatten KM.Advances in oral tongue reconstruction: a reconstructive paradigm and review of functional outcomes[J]. Curr Opin Otolaryngol Head Neck Surg, 2022, 30(5): 368-374.
[21] Gearing PF, Devine M, Sim F, et al.Reconstruction of tongue malignancy defects: a systematic review and treatment algorithm[J]. Microsurgery, 2025, 45(5): e70071.
[22] Zhong C, Xiong Y, Tang W, et al.A stage-wise residual attention generation adversarial network for mandibular defect repairing and reconstruction[J]. Int J Neural Syst, 2024, 34(7): 2450033.
[23] Benatar MJ, Dassonville O, Chamorey E, et al.Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases[J]. J Plast Reconstr Aesthet Surg, 2013, 66(4): 478-482.
[24] de Vicente JC, de Villalaín L, Torre A, et al. Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy: a functional assessment of radial forearm versus anterolateral thigh flap[J]. J Oral Maxillofac Surg, 2008, 66(11): 2270-2275.
[25] Chen H, Zhou N, Huang X, et al.Comparison of morbidity after reconstruction of tongue defects with an anterolateral thigh cutaneous flap compared with a radial forearm free-flap: a meta-analysis[J]. Br J Oral Maxillofac Surg, 2016, 54(10): 1095-1101.