副神经化上斜方肌肌皮瓣即刻修复舌鳞癌缺损的初步探索

目的 探讨副神经化上斜方肌肌皮瓣即刻修复舌鳞癌手术后舌体缺损的临床疗效.方法 收集2015年1月至2016年12月重庆医科大学附属口腔医院口腔颌面外科收治的6例经病理确诊的舌鳞癌患者,均行舌颈联合根治性颈清术,术中采用副神经和舌下神经吻合术的上斜方肌肌皮瓣同期修复舌缺损.供区创面直接拉拢缝合,未行植皮.结果 6例皮瓣全部成活.6个月至1年后,皮瓣呈现黏膜化,类似口腔黏膜形态,质地良好.再造舌的早期(3个月内)动度主要依靠残留舌体的运动.6个月后再造舌有明显动度,但灵活度较健侧差,患者对语言、吞咽等功能满意.结论 副神经化上斜方肌肌皮瓣是修复舌鳞癌术后缺损理想皮瓣之一.

Preliminary study on superior trapezius myocutaneous flap through accessory nerve anastomosis in reconstructing the tongue defect after the operation of tongue squamous cell carcinoma

Objective To explore the clinical effects of superior trapezius myocutaneous flap through accessory nerve anastomosis in immediately repairing the tongue defect after tongue squamous cell carcinoma operation.Methods Six cases of tongue squamous cell carcinoma diagnosed by pathology in the Maxillofacial Surgery Department of the Affiliated Stomatological Hospital of Chongqing Medical University from January 2015 to December 2016 were collected and Performed the tongue-neck combined radical operation.The superior trapezius myocutaneous flap simultaneous repair of tongue defect with accessory nerve and hypoglossal anastomosis was adopted during operation.The wound surface of donor site was directly sutured without skin grafting.Results All flaps survived.After 6 months to one year,the flap became mucolized,the surface of flap was similar to the normal oral mucosa with good character.The movement of reconstructed tongue mainly depended on the movement of residual tongue at early stage (within postoperative 3 months).After 6 monthsthe reconstructed tongue had obvious mobility,but the flexibility was poorer than that of the uninjured side,and the patient was satisfied with the language and swallowing function.Conclusion The superior trapezius myocutaneous flap through the accessory nerve anastomosis is one of the ideal skin flaps for repairing tongue defect after e tongue squamous cell carcinoma operation.