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1.
口咽癌的外科治疗 总被引:7,自引:1,他引:6
目的:探讨口咽癌扩大切除一期再建的手术方法,观察并发症及术后语言、吞咽功能恢复情况。方法:30例口咽癌中软腭癌2例,扁桃体癌3例,咽侧壁癌16例,舌根癌9例;Ⅲ、Ⅳ期患者占63.3%(19/30),颈淋巴结转移53.3%(16/30)。22例用下颌骨切开外旋或切除升支入路进行了肿块根治性切除,同期行颌下清扫术1例,肩胛舌骨肌上清扫术3例,根治性颈清扫术26例。咽部缺损用带蒂胸大肌皮瓣整复17例,胸锁乳突肌皮瓣4例,额顶部岛状皮瓣3例,斜方肌皮瓣和颈阔肌皮瓣各1例,游离前臂皮瓣+带蒂复合瓣4例。手术+放疗25例,单纯手术5例。结果:3年生存率为66.7%(14/21)。术后局部感染7例,涎瘘5例,皮瓣远端部分坏死4例,语言、吞咽功能基本恢复。结论:局部缺损范围和选择适宜的肌皮瓣是恢复腭咽闭合及舌可动性的主要因素,带蒂胸大肌皮瓣修复软腭、口咽侧壁及舌根大面积缺损效果良好。 相似文献
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颏下皮瓣修复头颈部恶性肿瘤术后缺损29例 总被引:1,自引:0,他引:1
手术治疗作为头颈部肿瘤治疗的重要手段,在近20年得到了长足的进步,带蒂皮瓣及游离皮瓣成功率的明显提高,使头颈部肿瘤的治疗水平得到进一步提高,减少了术后并发症,使术后外形和功能恢复更加满意[1-3].现回顾分析我科2001-2009年共29例口腔癌及口咽癌切除术后选择带蒂颏下皮瓣修复颊部、口底、舌根及口咽部组织缺损的结果. 相似文献
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马泓智房居高钟琦王琪冯凌何时知张洋廉猛王茹时倩赵延明陈佳铭 《中国耳鼻咽喉头颈外科》2023,(3):137-142
目的探讨在颈部增强CT指引下,制作根蒂位于肿瘤主体对侧的颏下穿支皮瓣(对侧颏瓣),同期修复喉咽恶性肿瘤术后缺损的可行性。方法回顾2021年1月~2022年9月首都医科大学附属北京同仁医院耳鼻咽喉头颈外科治疗的15例喉咽恶性肿瘤病例,病变分期为T2~4N0~2M0。术前依据患者颈部增强CT预判颏瓣回流静脉。主要手术方法:预制根蒂位于肿瘤主体对侧的颏瓣,大小为(15~20)cm×(6~7)cm,肿瘤切除后,以颏瓣修复咽喉缺损。15例患者中11例鳞状细胞癌行保喉手术,4例扩大全喉切除术。结果术前依据颈部增强CT观察颏瓣回流静脉:9例回流至颈内静脉,6例回流至颈外静脉,均与手术中颏瓣实际回流情况相符合。15例颏瓣均成活,术后1例感染,保喉者均可持续堵管,发音满意。15例均拔除鼻饲;随访1~21月,无肿瘤复发转移,1年生存率为100%。结论依据颈部增强CT可较准确预判颏瓣回流静脉。采用根蒂位于肿瘤主体对侧的颏瓣修复喉咽恶性肿瘤切除术后缺损,适用于患侧有明显淋巴结转移的病例,在确保彻底清扫病变侧颈淋巴组织的同时,提高颏瓣修复的成功率。 相似文献
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何时知房居高李平栋钟琦侯丽珍马泓智冯凌陈晓红时倩 《中华耳鼻咽喉头颈外科杂志》2020,(12):1126-1130
目的:探讨颏下动脉穿支皮瓣在咽喉癌术后缺损修复中的应用及效果。方法:回顾性分析2015年1月至2019年12月,首都医科大学附属北京同仁医院收治的27例行带蒂颏下动脉穿支皮瓣一期修复的口咽癌(10例)和下咽癌(17例)患者的病历资料,其中男23例,女4例,年龄40~70岁。口咽癌中扁桃体癌5例,其中4例行颈-口联合入路扁桃体癌扩大切除术,1例行下颌骨裂开扁桃体癌切除术,舌根癌5例均行经颈外舌骨入路舌根癌切除术;下咽癌中梨状窝癌16例,均行保留喉功能的部分下咽部分喉切除术,咽后壁癌1例行部分下咽切除术。分析颏下动脉穿支皮瓣修复口咽癌及下咽癌缺损的预后、吞咽功能和喉功能恢复情况。结果:27例患者随访时间为6~66个月,中位时间13个月。1例下咽癌患者因局部复发死亡,1例下咽癌患者因食管癌死亡,1例下咽癌患者舌根复发带瘤生存,余24例患者随访期间无复发和远处转移。估算2年生存率为92.9%,3年生存率为88.9%。术后并发症方面皮瓣坏死1例次,咽瘘1例次,皮下脂肪液化和积液2例次,淋巴瘘1例次。25例患者术后成功拔除气管套管,拔管率为92.6%,其中下咽癌拔管率为16/17,口咽癌拔管率为9/10。25例成功拔除鼻饲管,完全经口进食率为92.6%。结论:颏下动脉穿支皮瓣制备成功率高,修复口咽和下咽癌术后缺损能够很好的恢复吞咽和喉功能。 相似文献
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颏下皮瓣修复头颈肿瘤术后缺损的临床研究 总被引:5,自引:2,他引:5
目的 探讨颏下皮瓣在头颈肿瘤切除后组织缺损修复中的应用。方法 对口颊癌、硬腭癌、软腭癌、唇癌、舌癌及下咽癌切除后的组织缺损,用颏下皮瓣进行了一期修复。结果 18例头颈肿瘤病人中,14例皮瓣全部成活,2例腭部修复皮瓣部分裂开坏列,2例腭部修复皮瓣全部坏死。结论 颏下皮瓣在修复头颈肿瘤术后缺损中,具有操作方便,成活率高等特点,但在腭部修复中,易出现裂开坏死。 相似文献
6.
目的 探讨上臂外侧皮瓣在口咽癌切除后口咽部缺损修复中的应用。方法 回顾2020年5月~2022年10月首都医科大学附属北京同仁医院经治的10例口咽癌患者,6例人乳头状瘤病毒(HPV)相关口咽鳞状细胞癌,3例非HPV相关口咽鳞状细胞癌,1例为黏液表皮样癌。原发灶同时累及舌根、扁桃体、咽弓3例,同时累及扁桃体、软腭2例,累及舌根、扁桃体、会厌1例,同时累及扁桃体、舌根、咽弓及会厌舌面1例,同时累及舌根、杓会厌皱襞及会厌1例,同时累及扁桃体、舌根、软腭及后磨牙三角区1例,仅舌根受累1例。患者行经口联合经咽旁间隙入路口咽癌扩大切除术,切除后舌根、声门上、扁桃体等多部位缺损,采用游离上臂外侧皮瓣进行修复,分析上臂皮瓣的大小、血管蒂长度及血管直径,评估围手术期并发症,吞咽、呼吸及言语等功能恢复情况。结果 10例上臂外侧皮瓣均成活,无坏死。皮瓣大小(6×8)cm2~(6×15)cm2,血管蒂长度为6~8 cm,上臂皮瓣动脉的直径为1~2.5 mm,回流优势静脉直径为1.5~3.0 mm。所有患者只吻合1支静脉,8例为面静脉,2例为颈外静脉。术后14~45 d拔除胃管后经口进食。6例行术后放疗,剂量6... 相似文献
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目的探讨鼻咽、口咽、咽旁间隙肿瘤的手术方法。方法对2002年-2006年下颌骨外旋径路手术切除肿瘤并行局部修复治疗的3例鼻咽癌(2例放疗后复发,1例下咽癌术后鼻咽、口咽部巨大重复癌)、5例口咽恶性肿瘤(3例扁桃体鳞癌,2例颊黏膜鳞癌)、4例咽旁间隙肿瘤(1例脂肪瘤,3例混合瘤恶变)进行回顾性分析。术后缺损分别用胸大肌皮瓣修补3例,用游离前臂皮瓣修补4例,组织工程补片修复2例。结果随访8个月至4年,3例鼻咽癌患者中1例术后1年远处转移死亡,2例无瘤生存;3例扁桃体癌中2例无瘤生存,1例局部复发再次手术切除;2例颊黏膜鳞癌无瘤生存;1例脂肪瘤无复发,3例混合瘤恶变患者中1例6个月后死于远处转移,1例带瘤生存,1例无瘤生存。结论下颌骨外旋径路对于暴露鼻咽、口咽、咽旁间隙肿瘤视野良好,肿瘤可直视下完整切除,应用组织工程补片、带蒂或游离组织瓣进行I期修复,手术安全、可靠。 相似文献
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晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择 总被引:1,自引:0,他引:1
目的:探讨以不同组织移植物Ⅰ期重建晚期下咽癌、喉复发癌术后颈部、下咽食管缺损的适应证及治疗效果。方法:喉复发癌36例, 肿瘤切除后采用胸大肌肌皮
瓣修补组织缺损18例,肩胸皮瓣修补4例,胃代食管修补2例,胸部推移皮瓣重建下颈部与上纵隔组织缺损,并消灭手术死腔12例。晚期下咽癌16例,颈段食管癌8例,以游离空肠整复1例, 健侧喉黏膜瓣修复咽部缺损8例,喉气管代食道8例,胸大肌皮瓣修复咽部缺损2例,胃代食管2例,游离前臂皮瓣修复下咽1例。 结果:术中无一例死亡,术后无修复组织坏死 ,全部组织瓣存活。采用健侧喉黏膜瓣修复者,仅 1例有术前放疗史的患者发生术后咽漏,胸大肌皮瓣
修复者发生咽漏1例,胃代食道术后发生咽漏1例。全部病例愈合后均恢复正常饮食。随访 9~84个月,14例出现吞咽梗阻,可进流质饮食。结论:下咽癌患者术后组织缺损的修复方法各有侧重。肿瘤的部位和手术后组织缺损的大小是选择修复方法的首要因素;其次,应结合患者的年龄和全身状况,考虑减少并发症。 相似文献
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目的胸肩峰动脉穿支皮瓣(thoracoacromial artery perforator,TAAP)是近年来应用于颈部和咽部组织缺损的新技术,本文分析使用TAAP修复颈咽部缺损的经验。方法回顾分析2013年5月~2017年4月诊治20例TAAP修复咽瘘、咽部黏膜缺损和颈部皮肤缺损。本组患者年龄48~68岁,平均年龄53岁。下咽癌切除+全喉切除10例,保留喉功能的下咽癌切除7例,颈部皮肤缺损3例。咽部黏膜缺损4.5 cm×3 cm~6.5 cm×5 cm,颈部皮肤缺损5.5 cm×4 cm~8 cm×6 cm,皮瓣大小6 cm×4 cm~8 cm×6 cm。结果18例术后皮瓣成活,供区直接拉拢缝合,没有出现皮瓣坏死,其中15例行下咽黏膜修复的患者,术后2~5周恢复经口进食并行术后放疗,剂量60~67 Gy。另2例术中发现穿支血运障碍,更换成颏下皮瓣修复下咽缺损。随访3~36个月,1例术后14个月出现胸段食管癌,1例术后18个月出现纵膈淋巴结转移,均予以放化疗, 1例术后1年出现颈部淋巴结转移复发予以化疗,余病例无复发。结论胸肩峰动脉穿支皮瓣因为邻近颈部、血管相对恒定、皮瓣薄适用于修复咽部黏膜和颈段食管缺损;胸肩峰动脉为血管蒂的一蒂双岛的TAAP和胸大肌皮瓣同时修复复杂的颈部皮肤和咽部黏膜缺损。胸肩峰动脉穿支皮瓣的穿支细小,穿越锁骨下隧道时穿支区域和血管蒂不能扭曲,发现皮瓣血运异常应及时更换其他修复方法。 相似文献
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Kishore Sandu Philippe Monnier Philippe Pasche 《European archives of oto-rhino-laryngology》2012,269(4):1261-1267
The supraclavicular flap (SCF) is a fasciocutaneous flap used to cover head, oral, and neck region defects after tumor resection.
Its main vascular supply is the supraclavicular artery and accompanying veins and it can be harvested as a vascularised pedicled
flap. The SCF serves as an excellent outer skin cover as well as a good inner mucosal lining after oral cavity and head-neck
tumor resections. The flap has a wide arc of rotation and matches the skin colour and texture of the face and neck. Between
March 2006 and March 2011, the pedicled supraclavicular flap was used for reconstruction in 50 consecutive patients after
head and neck tumor resections and certain benign conditions in a tertiary university hospital setting. The flaps were tunnelized
under the neck skin to cover the external cervicofacial defects or passed medial to the mandible to give an inner epithelial
lining after the oral cavity and oropharyngeal tumor excision. Forty-four of the 50 patients had 100% flap survival with excellent
wound healing. All the flaps were harvested in less than 1 h. There were four cases of distal tip desquamation and two patients
had complete flap necrosis. Distal flap desquamation was observed in SCFs used for resurfacing the external skin defects after
oral cavity tumor ablation and needed only conservative treatment measures. Total flap failure was encountered in two patients
who had failed in previous chemoradiotherapy for squamous cell cancer of the floor of mouth and tonsil, respectively, and
the SCF was used in mucosal defect closure after tumor ablation. The benefits of a pedicled fasciocutaneous supraclavicular
flap are clear; it is thin, reliable, easy, and quick to harvest. In head, face and neck reconstructions, it is a good alternative
to free fasciocutaneous flaps, regional pedicled myocutaneous flaps, and the deltopectoral flap. 相似文献
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目的:探讨鼻唇沟带蒂皮瓣在修复鼻翼恶性肿瘤术后缺损的临床实用性和可行性。方法:对11例鼻翼恶性肿瘤患者行手术切除肿瘤,并根据鼻唇沟面部血供特点及缺损区大小设计出需要修复区域的长度、角度和体积,设计鼻唇沟面部带蒂皮瓣。经鼻侧移至缺损区修复鼻翼缺损区。结果:所有患者术后伤口均Ⅰ期愈合,皮瓣全部成活,血液循环良好,色泽良好,供区无明显瘢痕。术后随访1~5年,肿瘤无复发,外鼻美容修复效果满意。结论:鼻唇沟带蒂皮瓣血运丰富,易成活,可提供足够的组织量用以修复较大面积鼻翼缺损,且血管蒂长,转移灵活,操作简便,供区无明显瘢痕。鼻唇沟带蒂皮瓣是修复鼻翼恶性肿瘤切除术后较大面积缺损的最佳皮瓣。 相似文献
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颞浅血管为蒂的帽状腱膜瓣修复头颈肿瘤术后缺损 总被引:2,自引:0,他引:2
OBJECTIVE: To evaluate the advantage and applications of pedicled galeal flap in head and neck region. METHODS: A consecutive series of 17 patients underwent surgical reconstruction with pedicled galeal flaps after head and neck tumor resection. The defects included nasopharynx, skull base, maxilla, orbital base, oropharynx and oral cavity and the size ranged from 5 cm x 5 cm to 10 cm x 10 cm. The technique for using this flap was described and application was illustrated with 3 case reports. RESULTS: Complete success of galeal flaps for the reconstruction of head and neck defects was achieved in 13 of the 17 cases (76.5%) and partial necrosis was observed in the remaining 4 cases (23.4%). Immediate wound complications occurred in four cases, which resolved spontaneously. Four delayed complications were observed in 4 of 9 survival cases that included trismus (3) and alopecia (1). CONCLUSION: Galeal flap is a thin, pliable and well vascularised reconstruction tissue and is highly reliable. The donor site morbidity is minor. We have found the flap to be useful in the reconstruction of a variety of defects in head and neck, especially in skull base, orbital base, nasopharynx and oropharynx. 相似文献
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Xi Chen Han Zhou Yong-Jie Zhang Lin Yin Mei-Ping Lu Guang-Qian Xing Zi-Ping Lin Lei Cheng 《世界耳鼻咽喉头颈外科杂志(英文)》2015,1(1):44-49
ObjectiveTo explore the feasibility of the submental island flap in the repair of hypopharyngeal defects.MethodsWe collected wet specimens of fresh cadaveric heads from the Han Chinese adult population for applied anatomy of the submental island flap, and followed five patients with pyriform sinus carcinoma after reconstruction surgery using submental island flaps.ResultsWe found that the average length and width of the submental island flaps were (65.20 ± 11.69) mm and (46.70 ± 6.59) mm, respectively. The skin flap in all five patients survived after surgery, and tracheal tubes and gastric tubes were removed 7–36 days after surgery. Patients were followed up for 24–42 months, pharyngeal flaps grew well, and speech and swallowing functions were satisfactory.ConclusionThe submental island flap is a preferred material for the repair of hypopharyngeal defects after hypopharyngeal carcinoma resection, because of good blood supply, easy harvesting, and high survival rate. 相似文献
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The pectoralis major myocutaneous pedicled flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps for head and neck reconstruction, and several series of PMMPF procedures have been reported in the literature. Between 1983 and 1997, 244 reconstruction procedures using the PMMPF were carried out on 229 patients by the Otolaryngology-Head and Neck Surgery Department at the Toronto General Hospital. Pectoralis major myocutaneous pedicled flap reconstructions were completed after ablation of cancer in the following sites: oral cavity, 113; oropharynx/hypopharynx, 50; larynx, 59; and other, 21. The locations of reconstruction were oral cavity, 121; pharynx, 74; and neck or face, 50. Of the 244 cases, 202 were carried out as primary reconstructive procedures, whereas 42 flaps were "salvage" procedures (reconstruction after fistula, flap failure, osteoradionecrosis, and internal jugular vein rupture). Eighty-five cases (35%) were affected by complications such as dehiscence, infection, hematoma, seroma, partial flap failure, total flap failure, fistula, and donor site complications. The duration of admission for cases with complications was longer, and higher complication rates were associated with salvage procedures, number of comorbidities, number of pack-years of cigarettes smoked, and oral cavity reconstructions. This series of consecutive PMMPF procedures is the largest reported to date. 相似文献
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Wayne M. Koch 《The Laryngoscope》2002,112(7):1204-1208
Objectives The use, advantages, and disadvantages of the platysma flap were assessed. Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001. Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the χ2 test. Results Thirty‐four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions. Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects. 相似文献
18.
The extraordinarily rich blood supply of the tongue makes it possible to use a variety of pedicled tongue flaps: 1. Defects of the dorsum of the tongue can be covered either with island flaps from the margin or with flaps crossing the midline. 2. Medial defects can be covered by flaps taken from both sides or from the centre of the dorsum. 3. Defects of the tip of the tongue or the front of the floor of the mouth can be filled by island flaps taken from one or both sides of the tongue. Large defects can be crossed by a triangular island flap pulled through a tunnel. 4. For defects in the lateral floor of the mouth an oval shaped flap from the middle of the tongue is pulled through a tunnel into the defect. 相似文献
19.
Giuseppe Meccariello Filippo Montevecchi Alberto Deganello Giovanni D’Agostino Chiara Bellini Ermelinda Zeccardo Claudio Vicini 《Auris, nasus, larynx》2018,45(1):162-164
Trans Oral robotic surgery (TORS) is a prominent surgical approach for the resection of oropharyngeal tumors without division of the lip and mandible. The current practice following TORS is to allow the defect to heal by secondary intention, but some defects following TORS are large and complex enough to benefit soft-tissue coverage. In the free flap era, regional flaps are often overlooked albeit they still represent a valid alternative. In terms of cost-effectiveness, the use of alternative pedicled flaps in TORS framework probably reduced the risks of postoperative complications, with consequent expenditure restraints and reducing treatment costs arising from operating room duration and double surgical team. In this report we described the successfully use of the pedicled temporalis muscle flap for the reconstruction of the soft palate and lateral pharyngeal wall following TORS. This versatile and reliable flap may be a valid option in TORS framework. 相似文献