头颈部肿瘤修复皮瓣对放疗的耐受性

目的:探讨吻合血管的游离皮瓣组织对局部放疗的耐受性及安全性。方法:选取我院2015年至2018年收治的经皮瓣修补术头颈恶性肿瘤患者11例,采用适形调强放疗(IMRT)或旋转调强放疗(VAMT)常规分割剂量进行放疗,放疗期间及放疗结束后通过复查喉镜、颈部增强CT或MR,观察移植皮瓣急性放射性反应情况。结果:放疗过程中皮瓣组织表现为色素沉着、干性脱皮,且伴有不同程度的充血水肿,与周围放疗野内组织床相仿,反应程度随着放疗剂量的增加而加重。放疗结束后11例患者移植皮瓣无1例出现皮瓣坏死。放疗3个月后复查喉镜、颈部增强CT或MR,咽喉腔内颈阔肌皮瓣愈合良好,无出血坏死,2例患者皮瓣区充血水肿消退。胸大肌皮瓣修复的颈部淋巴结转移患者中,皮瓣区色素沉着有所缓解,术痕区愈合良好,无干性脱皮。结论:颈阔肌皮瓣、胸大肌皮瓣对于临床常规剂量(<70 Gy)术后放疗具有良好的耐受性,相对安全可靠。

Tolerance of the repair flap of head and neck tumor to radiotherapy

Objective:To evaluate the tolerance and safety of free flap tissue anastomosed to local radiotherapy．Methods:Eleven patients with head and neck malignant tumor treated by flap repair from 2015 to 2018 were treated with conventional fractionated dose of conformal intensity modulated radiotherapy (IMRT) or rotational intensity modulated radiotherapy (VMAT).Laryngoscopy CT and MR were performed during and after radiotherapy,the acute radiation response of the transplanted skin flap was observed.Results:During radiotherapy,the skin flap showed pigmentation,dry desquamate and hyperemia and edema,which was similar to that in the surrounding radiotherapy field.The degree of reaction was aggravated with the increase of radiotherapy dose.No flap necrosis occurred in 11 patients after radiotherapy.Laryngoscope and enhanced CT or MR of neck were performed 3 months after radiotherapy.Latissimus larynx flap healed well.Hyperemia and edema disappeared in the flap area in 2 patients without hemorrhage and necrosis.Pigmentation in the flap area was relieved in the patients with cervical lymph node metastasis repaired by pectoralis major flap.The scar area healed well,and there was no dry desquamate.Conclusion:The latissimus cervicalis flap and the pectoralis major myocutaneous flap have good tolerance for postoperative radiotherapy at a clinical dose of <70 Gy,and are relatively safe and reliable.