顎，顔面，口腔領域における進展再発癌に対する摘出術，再建術と2,3の問題点

Surgical Treatment for Advanced Recurrent Cancer of the Maxillofacial Region

　I．はじめに

　図1に示すような進展再発癌症例が，最後の救いを求めるかのように筆者らの外来を訪れることがある。顎，顔面，口腔の癌腫は高度に進展した状態でも局所の腫瘍が直ちに生命にかかわることはないが，治療によって局所腫瘍がコントロールされない限り，多くは顔面，口腔は徐々に破壊され，結局は遠隔転移，頸動脈破裂，または頭蓋内腫瘍進展のために死亡するまで，疼痛，醜形，悪臭，出血，摂食障害，構音障害などで苦しみ続けることになる。

　近年再建外科の発達により，従来は切除不可能であった頭頸部領域の進展癌症例に対しても，根治を目的とした拡大切除術が行われるようになった^1〜5）。筆者らの教室においても，開講以来，再発癌に対して根治切除が可能と判断された症例においては，わずかでも残されている根治への可能性を求めて，照射療法，化学療法，免疫療法との併用をもとに，かなり徹底した腫瘍切除術を行ってきた。

　The postoperative courses of 21 cases of advanced recurrent cancer of the maxillofacial region which were treated with combination therapy of pre-operative irradiation, extensive resection and primary reconstruction were evaluated. Three were alive more than 5 years and other 3 were alive more than 3 years, and other 3 were alive less than 3 years.

　Twelve patients died within 2 years due to distant metastasis. Secondary local recurrence was observed in 2 cases.

　Of 21 cases 2 were found unresectable due to invasion of the tumor in the skull base. Statistically considered, possibility of cure is very low, but there are certain cases which can be cured by combination therapy. Even when the intended cure could not be achieved, but if a localized tumor could completely be controlled, the patients might have a rather comfortable life until they eventually die with distant metastasis.

　Reconstructive procedures used were mainly combination of deltopectoral flap, forehead flap, scalping forehead flap and myocutaneous flap utilizing major pectoralis muscles.

　In cases which had heavy irradiation previously, free bone grafting for reconstruction of the mandibule was difficult to be taken, and utilization of the composite clavicle and deltopectoral flap or osteomyocutaneous flap was necessary.