舌癌根治术后游离前臂皮瓣一期舌再造术的改进

背景与目的：舌癌根治术造成半舌缺损,严重影响患者的生存质量。术中行一期舌再造术可保证手术创面的Ⅰ期愈合,使患者的吞咽及语言功能早日恢复,然而游离皮瓣再造舌时常发生的血管危象问题一直阻碍着这项手术的广泛开展。本文报告在应用游离前臂皮瓣行一期舌再造术中所做的一些改进方法,旨在提高其成功率。方法：对32例舌鳞癌患者在根治术中应用游离前臂皮瓣行一期舌再造,在皮瓣设计、制备和血管吻合等方面加以改进。结果：术后口腔和颈部创面均一期愈合,无涎瘘、乳糜漏、口底颌下瘘和感染等并发症发生;术后出现血管危象6例,5例抢救成功,1例失败,最终放弃皮瓣,移植成活率为96．9％。再造舌外形大部分良好,语言和吞咽功能恢复良好。结论：改进的游离前臂皮瓣舌再造术再造舌的成功率较高。     

桡侧前臂皮瓣和舌骨下肌肌皮瓣在半舌缺损修复中的比较

目的比较桡侧前臂皮瓣（radial forearm flap,RFF）和舌骨下肌肌皮瓣（infrahyoid myocutaneous flap,IHMF）修复半舌缺损的成功率和功能效果,探索和优化半舌缺损修复的技术方法。方法分别采用RFF（n=15）和IHMF（n=12）修复T2（n=22）、T3（n=5）舌癌术后半舌缺损。对比2组的手术成功率;以语言交流、进食、舌活动功能为参数评价和对比2组病例术后1年的舌功能状况。结果 RFF组15例皮瓣全部存活,无手术并发症发生;IHMF组12例发生单纯皮岛坏死1例,皮岛边缘缺血造成缝合口延迟愈合1例,无其它手术并发症发生。2组病例术后1年语言交流、进食、舌活动功能相近,P值均〉0.05。结论 RFF和IHMF修复半舌缺损均有较高的手术成功率和较低的手术并发症率,术后舌功能良好。对于手术耐受力较差的患者,IHMF在半舌缺损修复中可替代RFF。     

薄型股前外侧皮瓣修复中晚期舌癌术后组织缺损的临床疗效

摘 要：［目的］ 探讨薄型股前外侧皮瓣修复中晚期舌癌术后组织缺损的临床疗效。［方法］ 对85例中晚期舌癌术后组织缺损欲进行修复患者作为研究对象,按照修复皮瓣不同将其分为观察组与对照组,观察组43例,采用薄型股前外侧皮瓣进行修复,对照组42例,采用前臂桡侧皮瓣进行修复。对两组患者皮瓣存活率、术后并发症发生情况、舌功能恢复情况以及患者生活质量恢复情况进行比较。［结果］ 观察组患者皮瓣存活率为90.70%（39/43）,对照组为78.57%（33/42）,两组比较差异无统计学意义（P>0.05）。两组患者受区并发症发生率无显著差异（P>0.05）,而观察组患者供区并发症发生率明显低于对照组,差异有统计学意义（P<0.05）。两组患者在舌功能恢复情况方面比较差异均无统计学意义（P>0.05）。观察组患者术后生活质量恢复总有效率为83.72%,对照组为52.38%,观察组明显高于对照组,差异有统计学意义,且改善率有明显差别（P<0.05）。［结论］ 薄型股前外侧皮瓣修复中晚期舌癌术后组织缺损具有良好的临床疗效及安全性,有利于患者生活质量恢复,值得临床推广应用。     

舌肿瘤切除术后游离前臂皮瓣行舌缺损的再造与修复（附5例报告）

舌肿瘤切除术后游离前臂皮瓣行舌缺损的再造与修复（附５例报告）郑苍尚副主任医师张同盛，木合塔，邱志远新疆维吾尔自治区人民医院（８３０００１）舌肿瘤切除术后舌体的缺损修复和功能重建一直是口腔颌面外科医生追求的目标，我们自９２年以来，用前臂游离皮瓣血管吻合...     

38例舌癌切除后修复与再造术的临床体会

舌癌的外科手术治疗仍是当前治疗舌癌的首选手段,但常造成舌大部缺损或全舌缺损,给患者带来不同程度的吞咽、语言、咀嚼功能障碍及精神上的创伤。本文作者仅就1980年以来采用额瓣、前臂皮瓣和胸大肌肌皮瓣对38例舌大部切除和全舌切除的患者进行修复和再造,取得了较满意效果,现报道如下。临床资料一、年龄与性别本组38例中男34例,女4例。年龄最小30岁,最大70岁。二、肿瘤部位舌体癌21例,舌及口底癌14例.     

胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用。方法应用胸大肌肌皮瓣一期修复晚期头颈肿瘤术后缺损262例（其中折叠瓣17例修复口内外穿通性缺损,20例胸大肌肌膜瓣修复口内缺损,5例胸大肌皮瓣联合游离植皮修复咽瘘,5例胸大肌肌皮瓣联合游离皮瓣双瓣修复颌面部洞穿性缺损）。舌再造62例,修复口咽53例,修复口底41例,修复口颊24例,修复颈部31例,修复下咽缺损22例,修复腮腺区缺损29例。结果262例肌皮瓣252例全部成活,8例皮瓣部分坏死肌瓣成活,2例肌皮瓣完全坏死,总的成活率为99.2%（260/262）。术后随访1～10年,所有患者术后进食、吞咽功能恢复良好,语言功能大多恢复良好。结论胸大肌肌皮瓣血供可靠,组织量丰富,且应用较灵活,可制作成肌皮瓣或肌瓣,对于晚期头颈肿瘤术后缺损是最优选择。     

前臂皮瓣与股前外侧皮瓣修复口腔癌术后缺损的临床研究

目的 比较前臂皮瓣与股前外侧皮瓣在口腔癌术后缺损中的修复效果。方法 选取84例口腔癌术后缺损并行游离皮瓣修复术的患者为研究对象,按随机数字表法分为2组,各42例。对照组行前壁皮瓣修复,观察组行股前外侧皮瓣修复。观察至术后3个月,对比2组皮瓣成活率、手术情况、口腔功能、并发症。结果 2组皮瓣成活率、皮瓣制作时间、住院时间、口腔开合、吞咽、咀嚼、语言功能评分相比,差异无统计学意义(P>0.05);观察组手术时间长于对照组,皮瓣面积大于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论 前臂皮瓣与股前外侧皮瓣均具有良好的皮瓣成活率,可有效改善口腔癌术后缺损患者的口腔功能,且治疗效果相当。前臂皮瓣修复手术时间短,股前外侧皮瓣修复术后并发症少,临床应根据患者具体情况选取适当的皮瓣修复。     

前臂皮瓣修复舌鳞状细胞癌术后舌缺损患者的术后生存质量观察

目的比较前臂皮瓣修复与游离股前外侧皮瓣修复对c N0期舌鳞状细胞癌术后舌缺损患者术后生存质量的影响。方法纳入52例c N0期舌鳞状细胞癌患者,手术方案均为改良肩胛舌骨上颈部淋巴结清扫术(MSOHND),舌部缺损分别采用游离桡侧前臂皮瓣修复(研究组)与游离股前外侧皮瓣修复(对照组)。术后12个月,进行生存质量问卷(UW-QOL)调查,对两组患者生存质量进行评估。另观察两组患者抑郁情况。结果 UW-QOL评分显示,研究组肩活动、吞咽、语言、肩功能以及总得分分别为(68.1±19.0)、(59.1±14.1)、(55.5±20.3)、(57.3±27.9)、(897.5±65.2)分,对照组肩活动、吞咽、语言、肩功能以及总得分分别为(84.4±18.6)、(78.2±19.8)、(80.1±20.4)、(89.4±16.0)、(754.2±101.3)分,上述指标研究组均优于对照组,差异有显著性(P<0.05)。观察组SAS、SDS、SES评分分别为(36.5±4.1)、(32.9±3.0)、(24.5±4.1)分,对照组SAS、SDS、SES评分分别为(42.0±4.2)、(39.6±4.1)、(18.4±3.1)分,研究组显著优于对照组(P<0.05)。结论 c N0期舌鳞状细胞癌患者进行MSOHND及前臂皮瓣修复,能够有效改善患者术后生存质量,值得推广。     

对侧胸廓内动脉穿支皮瓣修复巨大胸壁缺损或即刻乳房重建

目的探讨单侧乳腺癌改良根治术同时行对侧胸廓内动脉穿支皮瓣修复巨大胸壁缺损或即刻乳房重建的可行性及临床价值。方法回顾分析2013年7月至2016年5月安徽医科大学第一附属医院收治8例内乳区巨大乳腺癌患者的临床资料,其中7例患者行新辅助化疗。8例患者均在单侧乳腺癌改良根治术同时行对侧胸廓内动脉穿支皮瓣修复巨大胸壁缺损(1例)或即刻乳房重建(7例),且8例患者均同时行对侧乳房缩乳上提术,其中3例患者同时联合假体乳房重建术,4例患者同时行双侧乳头乳晕重建术。术后予以综合治疗。统计患者手术时间及住院时间,观察皮瓣成活情况及术后并发症,并调查患者对手术效果的满意度。结果平均手术时间为3.0 h(2.3~4.8 h)。平均住院时间为8.9 d(7.0~14.0 d)。进行了4~33个月的随访,中位随访23个月。术后8例皮瓣均未见坏死。1例皮瓣淤血,1例出现皮下积液,经过抽液后痊愈。患者供体区域未见明显并发症,对侧乳腺未见原发乳腺癌及远处转移。所有患者均对修复或者重建效果满意。结论对侧胸廓内动脉穿支皮瓣适用于特定人群的胸壁缺损修复或乳房重建,患者恢复快及供皮瓣区并发症低为其优点,尤其适用于内乳区巨大乳腺癌患者。     

胸大肌肌皮瓣在舌再造术中的应用

报告舌癌行全舌,或舌大部或舌根广泛切除术后,应用胸大肌皮瓣行舌再造术的经验。方法 自１９８４年１２月至１９９５年９月,我院对８６例Ｔ３或Ｔ４舌癌根治术后的舌缺损,应用带蒂胸大肌肌皮瓣同期进行了舌再造术。结果 肌皮瓣全坏死１例。术后吞咽和语言功能恢复正常分别为５９例和４４例。     

胸大肌肌皮瓣在晚期头颈肿瘤术后组织缺损重建中的应用

背景与目的:晚期头颈肿瘤外科治疗时,留下的完全或者不完全的组织缺损,是目前头颈外科的一个难点。胸大肌肌皮瓣在头颈肿瘤术后组织缺损重建中仍起着不可替代的作用。本研究旨在探讨胸大肌肌皮瓣在头颈缺损重建中的适应指征,提高胸大肌肌皮瓣修复的成功率。方法:中山大学肿瘤防治中心2004年1月至2007年1月间共22例行胸大肌肌皮瓣重建头颈肿瘤术后缺损患者,其中颈部大面积皮肤缺损8例,口咽缺损4例,舌缺损5例,口底缺损3例,下咽缺损2例;13例患者采用血管蒂穿行锁骨下,9例经锁骨上转移至颈部;重建的最大面积为15cm×12cm,最小面积为8cm×5cm。结果:无手术死亡病例,1例出现皮瓣坏死,1例出现部分皮瓣坏死,皮瓣重建成功率为95.5%;手术后并发症伤口积血1例,口底瘘1例,并发症发生率为9.1%(2/22)。结论:胸大肌肌皮瓣是头颈肿瘤术后组织缺损重建的良好供区皮瓣,是颈部大面积皮肤缺损重建的首选皮瓣;血管蒂穿行锁骨下可以增加胸大肌肌皮瓣的修复半径,且有利于保护血管蒂不受压迫。     

食管胃舌状黏膜瓣的制作和抗返流吻合技术的临床应用

目的：探讨食管胃舌状黏膜瓣的制作和抗返流吻合方法及其抗返流的临床效果。方法按设计要求进行食管胃舌状黏膜瓣的制作和食管胃吻合及胃舌状黏膜瓣的制作和食管胃吻合。结果全组460例手术顺利,术后患者均可平卧。部分病例复查钡餐未见明显返流,术后24 h PH值测定均无返流,复查胃镜仅见吻合口轻微炎症反应,吻合口上方食管黏膜光滑,未发现返流性食管炎改变。结论食管胃舌状黏膜瓣吻合具有良好的抗返流作用,效果良好。     

带蒂皮瓣联合全层口腔粘膜移植进行上眼睑功能性再造

目的探索一种简单易行且能获得比较理想眼睑功能的上眼睑成形术。方法对12例由于肿瘤切除术和外伤导致的上眼睑完全或近完全缺失患者，应用颧面部的带蒂皮瓣联合口腔全层粘膜片移植进行上眼睑再造，一期手术形成成活的眼睑，二期手术形成具有启闭功能和比较良好外观的眼睑。结果12例上眼睑再造获得成功，且获得良好的眼睑启闭功能。结论在上眼睑完全缺失的眼睑再造中，带蒂皮瓣联合口腔全层粘膜移植是安全有效易行的方法。     

Functional and sensitive outcomes after tongue reconstruction: about a series of 30 patients

Few studies reported both functional and sensitive long-term evaluations after tongue reconstruction. The aim of this study was to assess functional outcomes and sensitive recovery after tongue reconstruction with fasciocutaneous free flap (FCFF) or musculocutaneous pedicled flap (MCPF) without nerve anastomosis. We enrolled 30 patients having no recurrence from a consecutive series of 79 tongue reconstructions as part of a cancer treatment. All patients were submitted to functional and sensitive tests. The functional study included intelligibility, tongue motility, food, and swallowing scores. Flap sensibility was evaluated too. Male-to-female sex ratio was 6.5 with a mean age of 52 years old. The lesions were mainly advanced (T3-T4 73%). Mobile tongue and base of tongue resection was carried out in 43% of cases, and resection was limited to the oral tongue for 53%. Twenty-one FCFF and nine MCPF were performed. The mean follow-up was 2 years and 11 months. Swallowing (slightly impaired 63%), food (normal 40%), and intelligibility (excellent 77%) assessments were satisfactory. Spontaneous sensory recovery was regularly observed (mean response 62%). The two groups FCFF and MCPF were similar regarding population and tumors characteristics. Functional results were higher in case of FCFF (food score p=0.05; intelligibility p=0.04). No difference was observed on sensitive recovery. This study emphasizes good functional results either for swallowing or intelligibility, with higher scores for the FCFF, strengthening the opinion that FCFF is the best choice for tongue reconstruction whenever possible.     

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

BackgroundThe submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction.Materials and methodsA total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported.ResultsThe study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31–79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3–62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences.ConclusionsSIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.     

Larynx preservation surgery for advanced posterior pharyngeal wall carcinoma with free flap reconstruction: a critical appraisal

To report the functional and oncologic results of larynx preservation surgery with free flap reconstruction for posterior pharyngeal wall carcinoma. Retrospective medical chart review. Tertiary care referral center. We present a series of seven patients, who were treated for an advanced stage posterior pharyngeal wall carcinoma between 1995 and 1998. All patients underwent posterior pharyngectomy with larynx preservation via a suprahyoidal approach for carcinoma of the posterior pharyngeal wall, with radial forearm free flap reconstruction. Complications occurred in three patients with grade 3 comorbidity, one of whom suffered flap loss. After a mean follow-up of 48 months, three patients are alive without disease. One patient is alive with a second primary tongue carcinoma. Two patients died of disease, whereas one patient died of another cause. All patients could be decannulated and maintain their voice. Six out of seven patients were able to take oral nutrition, although four patients needed additional PEG-tube feeding. Posterior pharyngectomy with larynx preservation and radial forearm free flap reconstruction is feasible in selected patients, with acceptable functional results and survival. However, the patient must be aware of the risk of chronic aspiration and the possibility of long-term PEG feedings.     

胸外侧筋膜皮瓣填充乳腺癌保留乳房手术后组织缺损的临床应用研究

目的探讨乳腺癌保留乳房手术中利用胸外侧筋膜皮瓣填充组织缺损的效果和可行性。方法在乳腺癌保留乳房手术中,先行肿瘤扩大切除术,切缘距离瘤缘至少0.5cm,同时切除肿瘤表面受侵的皮肤,设计三角形胸外侧筋膜皮瓣用以填充组织缺损,并利用此皮瓣切口完成腋窝淋巴结切除。结果共完成7例,切除肿瘤的最大直径为5.5cm,切缘均无癌残留,有3例切除乳头、乳晕复合体。平均手术时间3h,平均出血量300ml。术后未发生皮瓣坏死等并发症。术后平均随访19.5个月,均未出现复发,美容效果均为优良,患者对乳房外形的自我感觉均为满意。结论在乳腺癌保留乳房手术中,利用胸外侧筋膜皮瓣填充组织缺损的效果满意,可以使一部分失去保留乳房手术机会的妇女接受保留乳房手术治疗。