带蒂肌皮瓣及脏器瓣在咽、食管缺损修复中的应用

目的 探讨带蒂组织瓣在咽、食管术后缺损修复中的应用。 方法 2002年1月至2011年12月山东大学齐鲁医院耳鼻咽喉科对因头颈部恶性肿瘤住院的患者行手术治疗,单独或联合应用胸大肌肌皮瓣、舌瓣、喉气管瓣、胃代食管术、结肠上徙术整复咽部及食管的术后缺损,共计186例,对此类患者进行随访并分析治疗效果。 结果 喉癌4例,喉癌术后复发14例,喉癌术后咽瘘4例,喉癌术后咽狭窄1例,下咽癌87例,下咽癌术后咽瘘11例,甲状腺癌5例,扁桃体癌2例,颈段食管癌38例。应用胸大肌肌皮瓣共71例;舌瓣联合喉气管瓣、胸大肌肌皮瓣运用2例,术后均拔除鼻饲管;喉气管瓣40例;胃代食管术58例,55例恢复吞咽功能,喉功能保留率53.4%;结肠上徙术共15例,13例恢复吞咽功能,喉功能保留率93.3%。 结论 带蒂组织瓣因其血供良好,制备简单,技术成熟,无需特殊手术技巧的优势,可满足耳鼻咽喉头颈外科术后修复与重建的要求,在头颈一期整复重建中发挥重要作用。

The application of pedicle tissue flaps in reconstruction of pharyngeal and esophageal defects in head and neck surgery

Objective To evaluate the application and outcomes of pedicle tissue flaps in reconstruction of pharyngeal and esophageal defects in head and neck surgery. Methods This was a retrospective analysis of 186 operative cases in patients with malignant diseases in the Department of Otolaryngology, Qilu Hospital of Shandong University. The patients underwent reconstruction of defects using pectoralis myocutaneous flaps, sternohyoid flaps, tongue flaps, laryngotracheal flaps, pharyngogastric anastomoses, and pharyngocolonic anastomoses. Results Four patients had laryngeal cancer, 87 had hypopharyngeal cancer, 5 had thyroid cancer, 2 had tonsil cancer, 38 had cervical esophageal cancer, and 15 had pharyngocutaneous fistulas. Reconstruction was performed with single or combined pectoralis major myocutaneous flaps in 71 cases; 2 underwent reconstruction with a tongue flap combined with laryngotracheal and pectoralis major myocutaneous flaps, with recovery of swallowing function; 38 of 40 underwent reconstruction with laryngotracheal flaps, with recovery of swallowing function; 55 of 58 underwent reconstruction with single or combined pharyngogastric anastomoses, with recovery of swallowing function, and with preservation of laryngeal function in 53.4%; and 13 of 15 underwent reconstruction with single or combined pharyngocolonic anastomoses, with recovery of swallowing function, and with preservation of laryngeal function in 93.3%. Conclusion Pedicle tissue flaps meet the requirements for reconstruction of pharyngeal and esophageal defects in head and neck surgery. These flaps have a good blood supply, mature technology, and are easy to perform, requiring less operative skill. Moreover, these flaps play an important role in one-stage reconstruction in head and neck surgery when used flexibly.