喉切除后气管造瘘口复发癌

喉切除术后气管造瘘口复发癌的发生是影响喉癌、下咽癌及颈段食管癌患自下而上的重要因素。为提高临床医师对该病的认识和正确合理地制定喉癌、下咽癌及颈段食管癌的治疗方案，本综述喉切除后气管造瘘口复发的病因、发病机理、间隔时间、治疗、预后及预防。     

气管造口复发癌的处理

OBJECTIVE: To study effective prevention and treatment of stoma recurrence after laryngectomy. METHODS: A retrospective review of 23 patients with stomal recurrence after laryngectomy was conducted. Among all 23 cases, 20 cases were referred to Cancer Hospital of Chinese Academy of Medical Science from other hospitals. The etiopathology of stomal recurrence after laryngectomy, feasibilities of various kinds of operative treatment and outcomes of clinical management in this series were analyzed. RESULTS: The subglottic extension and invasion of paraglottic portion of laryngeal cancer and peritreacheal metastasis may result in stomal recurrence. The survival period of 18 cases surgically treated was longer than that of 5 cases untreated or irradiated and/or chemotherapied. The 1- and 5-year survival rates were 40.7% and 20.4%, respectively. The common complication was pharyngeal fistula. Surgical treatment may relieve local pain, improve breathing, resume swallowing and decrease cancer ulcer bleeding. CONCLUSIONS: The overall prognosis of peristomal recurrence after laryngectomy was awful and dismal. Prevention should be stressed in surgical treatment of the subglottic extension, invasion of paraglottic portion and peritreacheal node metastasis. A proper surgical treatment in some cases of stomal recurrence would prolong the lifetime and advance the life quality of the patients.     

改良胸大肌肌皮瓣在高风险头颈肿瘤患者术后缺损修复的应用

目的 总结改良带蒂胸大肌肌皮瓣（PMMF）在高风险头颈肿瘤患者术后缺损组织修复中的体会和应用价值。方法选择我院2017年2月～2021年10月,17例头颈恶性肿瘤并均伴高风险（高龄、放疗后、糖尿病、心血管疾病、动脉硬化、周围血管病）患者,手术治疗导致头颈部、口腔颌面大范围缺损采用胸大肌肌皮瓣同期修复的效果观察。结果 17例均顺利完成手术并度过围手术期,1例（糖尿病酮症,血糖波动较大、血糖控制不理想）咽瘘,经积极换药,对症治疗后愈合,2例皮瓣远端局部坏死,换药,缝合对症治疗后愈合,1例（外院术后+放疗30次复发）术后下颌部皮瓣远端裂开、瘘,未完全愈合。1例皮瓣稍过臃肿,重建舌体偏健侧,自觉言语不清,有不适感,3个月后复查臃肿较前减轻,言语稍有不清但基本能听懂,亦无明显不适感,吞咽正常。1例术后颈部瘢痕挛缩至仰头不适,予二次手术松解后恢复良好。余病例组织缺损、伤口愈合,患者头颈部功能及语音与吞咽功能均修复。结论 改良胸大肌肌皮瓣（PMMF）血管恒定、制作简单,血供丰富、成活率高,供区位于头颈部放射野外,可为经放射治疗后头颈、口腔颌面区提供健康组织,组织量大,可做为高风险（高龄、放疗后、糖尿...     

胸大肌肌皮瓣修复晚期口咽侧壁肿瘤手术缺损

对18例晚期口咽侧壁肿瘤患者的术后缺损，用胸大肌肌皮瓣修复。取瓣面积为15cm×10cm～3cm×3cm；3例发生部分坏死，4例行预防性气管切开；术后外形及口咽功能恢复均满意。术后3年和5年生存率分别为61．5％和40．0％。皮瓣的愈合与本前放疗及术中操作等因素有关。认为晚期口咽侧壁肿瘤术后缺损应首选胸大肌肌皮瓣作一期修复，以提高患者生存质量，延长其生命。     

胸大肌肌皮瓣修复头颈肿瘤术后缺损10 例

我院于 1 991年 4月至 2 0 0 0年 9月采用胸大肌肌皮瓣 ( ｐｅｃｔｏｒａｌｉｓｍａｊｏｒｍｙｏｃｕｔａｎｅｏｕｓｆｌａｐ ,ＰＭＦ)修复头颈肿瘤术后缺损 1 0例 ,疗效满意 ,现报告如下。1　资料与方法1 .1 　 一般资料1 0例均为男性 ,年龄 2 4～ 68岁。下咽鳞癌 5例 ,其中Ｔ4Ｎ2 Ｍ0 2例 ,Ｔ4Ｎ2ｂＭ0 2例 ,Ｔ4Ｎ1 Ｍ0 1例 ;口底鳞癌 (Ｔ4Ｎ1 Ｍ0 ) 2例 ,下牙龈鳞癌 (Ｔ4Ｎ1 Ｍ0 )和舌根横纹肌肉瘤 (Ｔ4Ｎ0 Ｍ0 )各 1例 ,腮腺癌(Ｔ4Ｎ2 Ｍ0 ) 1例。下咽癌均侵犯食管入口 ,腮腺癌侵犯局部皮肤红肿溃烂。1 .2 　 治疗方法5例下咽癌作了气管…     

带蒂胸大肌肌皮瓣1期修复咽喉肿瘤术后缺损

目前 ,治疗咽喉部肿瘤多主张外科治疗或以外科为主的综合治疗。肿瘤切除后遗留局部巨大缺损 ,常牵涉口咽、喉咽、口腔和喉部缺损重建。如何迅速恢复术后的喉功能是保证和提高患者生活质量的重要条件。 1991年以来 ,我科对 18例咽喉部肿瘤切除后 ,利用带蒂胸大肌肌皮瓣 (ｐｅｃｔｏｒａｌｉｓｍａｊｏｒｍｙｏｃａｔａｎｅｏｕｓｆｌａｐ ,ＰＭ ) 1期修复术后缺损 ,配合放疗和化疗 ,效果较满意。报告如下。1　资料与方法1.1　 临床资料18例中 ,下咽癌 5例 ,均男性 ,年龄 4 4～ 6 5岁。ＵＩＣＣ(1997)肿瘤分期〔1〕:Ｔ3Ｎ1Ｍ0 1例 ,肿瘤位于右…     

气管瘘口复发癌治疗方法探讨

喉全切除术后造瘘口复发癌(stomal recurrence after laryngectomy)是指气管断端与皮肤缝合处肿瘤组织弥漫型浸润,一般累及造瘘口周围皮肤、气管旁软组织、食管,可下延至纵隔,是喉、下咽恶性肿瘤术后非常严重的复发病灶.此类患者多有手术、放疗史,颈部组织粘连严重,同时复发肿瘤常常发展很快,侵犯范围较广,切除时常需扩大切除病灶,缺损的器官和组织需要重建和修复,以上这些因素均增加了手术治疗的难度.现结合我院2009年7月收治的1例气管瘘口复发癌患者的治疗经过并复习相关文献,以探讨气管瘘口复发癌的治疗方法.     

胸大肌肌皮瓣在头颈部组织缺损修复中的应用

胸大肌肌皮瓣近年来被广泛地应用于耳鼻咽喉-头颈外科,我科2000~2003年应用胸大肌肌皮瓣治疗各类病人10例,取得满意疗效。1资料与方法1.1临床资料10例中,男8例,女2例;年龄32~62岁,其中喉咽癌2例,喉癌部分切除加放疗后复发2例,上颌窦癌侵犯面颊部皮肤2例,颈部烧伤1例,电击伤1例,爆震伤合并感染1例,挫伤合并感染1例。1.2方法1.2.1缺损区处理恶性肿瘤病人首先行肿瘤切除术,肿瘤切除要彻底,决不可迁就皮瓣而遗留病变组织。切除时要有0.5~1.0 cm安全缘,切除后,生理盐水反复冲洗创面,对外伤而致组织缺损要彻底清创,用生理盐水、3%双氧水、庆大霉素…     

胸大肌肌皮瓣在头颈部组织缺损修复中的应用

目的　评价胸大肌肌皮瓣在头颈部各类病变术后组织缺损修复中的应用效果。方法　 1 998年 5月～2 0 0 3年 1 0月我科应用胸大肌肌皮瓣对 4 7例病人头颈部病变术后组织缺损进行Ⅰ期修复 ,皮瓣面积为5cm× 6cm～ 1 5cm× 30cm。结果　 4 4例 (93.6 %)胸大肌肌皮瓣完全存活 ,3例 (6 .4 %)胸大肌肌皮瓣部分坏死。结论　胸大肌肌皮瓣血供可靠、组织量多、修复操作简单 ,能满足头颈部各类病变术后组织缺损的修复。     

胸大肌肌皮瓣修复口腔颌面部缺损的并发症——168例临床分析

目的：回顾分析胸大肌肌皮瓣修复口腔缺损的并发症,明确并发症发生有关的因素,探讨减少其发生的措施。方法：对１９９０－１９９６年所行１６８例应用带蒂胸大岂皮瓣修复口腔颌面部缺损的病人临床资料进行多顺归分析。１６８例患者中,男性１２０例,女性４８例,年龄２６－７９岁,：１６８例皮瓣中,２５例出现不同程度坏死（１４．９％）;２２例发生瘘管（１３．１％）;伤口感染３９例（２３．２％）。与并发症有关的因素有多     

胸大肌肌皮瓣在头颈肿瘤术后组织缺损修复中的应用

目的总结胸大肌肌皮瓣在头颈肿瘤术后组织缺损修复中的应用。方法回顾性总结2 0 0 7年1月～2 0 1 0年1 2月收治的3 6例患者因头颈部肿瘤手术后巨大组织缺损应用胸大肌肌皮瓣进行修复的临床资料。结果 32例(88.9%)胸大肌肌皮瓣完全存活,4例(11.1%)胸大肌肌皮瓣远端部分坏死。经换药、口腔护理等对症支持治疗后愈合。结论胸大肌肌皮瓣是一种临床应用广泛的修复材料。它具有丰富的组织量和确切的血液供应,修复操作简单,易存活,适用于头颈部肿瘤扩大切除术后组织缺损的即刻修复。     

Reconstruction of the hypopharynx with U-shaped pectoralis major myocutaneous flap after total pharyngo-laryngectomy

Resection of the whole circumference of the pharynx and esophagus is usually reconstructed with gastric pull-up, jejunum free graft or free forearm flap. The aim of this study was to assess the use of pectoralis major myocutaneous flap for closure of total pharyngeal defect. In 11 patients with hypopharynx and larynx cancer, total pharyngo-laryngectomy and excision of the cervical part of the esophagus and neck dissections were performed; the defects were closed with pectoralis major myocutaneous flaps. The skin island was sutured to prevertebral muscles, forming a letter U shape. Good healing was obtained in six patients, and five patients developed fistula that closed spontaneously within 3–4 weeks. The use of U-shaped pectoralis major myocutaneous flap, suturing it to prevertebral muscles, gives good functional results, and it is a simple and time-saving second choice method of reconstruction of the pharynx after total pharyngo-laryngectomy.     

Re-use of pectoralis major myocutaneous flap for the treatment of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy: a case report

Management of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy is a challenging problem. Because of previous surgery, free flaps may not always be performed. We report a case of recurrent hypopharyngeal stenosis after a first attempt of reconstruction with a pectoralis major myocutaneous pedicled flap (PMMPF) failed. The problem was solved by reusing the previous PMMPF as a rotary door flap according to Eliachar and suturing it to the prevertrebral fascia according to Spriano. The follow-up is now of 9 months without recurrence. This new technique is described and discussed in comparison with other possible options.     

Treating tracheo-innominate artery fistula with interposition of a pectoralis major myocutaneous flap

Tracheo-innominate artery fistula (TIF) is an uncommon life-threatening complication of tracheostomy. A prompt diagnosis and surgical intervention can save the life of a TIF patient. Several methods of reconstructing the tracheal defect have been reported, but may not be available in the presence of extensive infection. We used a trough and pectoralis major myocutaneous flap to treat a TIF patient with a large tracheal defect and severe infection who had to be ventilated mechanically. This may be a useful option in the treatment of this rare, devastating complication of tracheostomy.     

胸大肌肌皮瓣在侵犯下咽晚期头颈鳞癌手术切除术后缺损修复中的应用

目的 探讨不同情况下应用胸大肌肌皮瓣(PMF)修复下咽颈食管区域重要和复合缺损的方法和可行性。 方法 采用PMF单独或联合其他修复方法,结合对修复方法的改良,采用不同方式修复晚期和复发性下咽癌和喉癌侵犯下咽颈食管区域手术切除术后下咽颈食管巨大和复合性缺损59例,缺损类型包括下咽颈食管部分缺损、下咽颈食管环周缺损以及下咽颈食管缺损合并颈前软组织巨大复合缺损。 结果 完成单纯PMF覆盖法26例,椎前筋膜游离植皮加PMF覆盖4例,PMF覆盖加颈前表面游离植皮2例,PMF覆盖下咽加胸三角皮瓣(DPF)修复颈前缺损2例,单纯PMF皮管16例,PMF皮管加肩胸皮瓣表面覆盖4例,胃上提加PMF覆盖3例,双岛瓦合PMF 2例。术后20例出现了不同程度并发症,除1例院内死亡外,其余均经妥善处理治愈,恢复吞咽功能。 结论 PMF适合各种情况的下咽颈食管缺损修复,特别是在颈部同时伴有巨大软组织复合缺损时,这种方法更具优越性。     

带蒂胸大肌皮瓣在头颈部肿瘤术后缺损修复中的应用

目的:探讨运用带蒂胸大肌皮瓣修复头颈部肿瘤切除术后缺损的效果及优点。方法:13例晚期头颈部肿瘤患者,行肿瘤切除术后以带蒂胸大肌皮瓣修复术后缺损。结果:术后11例愈合良好;1例出现腮腺瘘,加压包扎后愈合;1例自动出院后失访。结论:胸大肌皮瓣修复头颈部肿瘤切除术后缺损,具有血供丰富、可修复较大面积缺损、术后愈合较好等优点。对延长患者生命,减轻病痛有重要作用。     

双岛胸大肌皮瓣在头颈肿瘤切除、重建术中的应用

目的 探讨双岛胸大肌皮瓣在头颈肿瘤术后组织缺损修复重建应用的效果及优点。方法 应用双岛胸大肌皮瓣,对头颈肿瘤术后组织缺损的8例患者进行修复重建。结果 重建后的咽腔无狭窄,颈部皮肤均成活。皮瓣I期愈合7例;皮瓣重建颈部皮肤面边缘轻度坏死1例,经处理后愈合。患者于术后8～12d(平均10d)开始进食;术后14～20d(平均16d)出院。结论 双岛胸大肌皮瓣血供丰富,组织量多,是同时修复头颈肿瘤术后皮肤、黏膜双重缺损的优选方法。     

Fracture of the clavicle following the island type of pectoralis major myocutaneous flap for reconstruction of head and neck defect

Fractures of the clavicle following radical neck dissection (RND) and/or radiation therapy have been previously noted in the literature. Interestingly, we experienced three cases of clavicular fracture, which were considered to have resulted from pectoralis major myocutaneous flap (PMMCF). All of these three cases had received the combined treatment of RND, PMMCF and postoperative radiotherapy on the side of fracture. In all three cases, ipsilateral lower neck received 4,500 cGy and island type of PMMCF was used for reconstruction of surgical defect in head and neck area. All fractures noted between 1 and 3 years postoperatively occurred on the medial portion of the clavicle. Devascularization after stripping of periosteum and altered mechanics of the clavicle following resection of clavicular head of pectoralis major muscle may contribute to develop this rare complication in addition to the effect of radiotherapy and RND. We present three cases of the clavicle fracture following the island type PMMCF with a review of literature.