胸大肌肌皮瓣用于咽喉晚期肿瘤术后一期修复

目的]探讨胸大肌肌皮瓣在咽喉晚期肿瘤术后一期修复中的应用价值.方法]对1996年6月到2004年6月55例咽喉晚期肿瘤根治术后一期应用胸大肌肌皮瓣修复的资料进行分析总结.其中舌根癌19例、扁桃体癌10例、喉咽癌9例、喉癌9例、鼻咽癌8例.术前放疗21例,术后放疗25例.胸大肌肌皮瓣修复咽喉部黏膜及黏膜下软组织缺损40例,修复颈部皮肤缺损15例.结果]55例胸大肌肌皮瓣均一期修复完成.1例肌皮瓣皮肤完全坏死失败,3例肌皮瓣远端皮肤少许坏死重新清创缝合,修复成功率为98.2%(54/55).40例修复咽喉部黏膜缺损病人有3例进食轻度呛咳,1例进食吞咽不畅外均恢复吞咽功能,除全喉切除病人外均基本恢复语言功能.15例修复颈部皮肤缺损病人切口均愈合.3、5年存活率舌根癌为4/8,2/5;扁桃体癌为3/6,2/4;喉咽癌为2/4,1/3;喉癌为2/3,1/2;鼻咽癌为2/4,1/3.结论]胸大肌肌皮瓣血供可靠,组织容量大,在咽喉部晚期肿瘤手术中应用可以提高存活率及病人术后生存质量,成功率高,是一期修复的理想材料.

One-stage Operative Reconstruction with Pectoralis Major Myocutaneous Flap for Operative Defect in Advanced Pharyngolaryngeal Cancer

To investigate the value of reconstruction with pectoralis major myocutaneous flap for one-stage operation in advanced pharyngolaryngeal cancer. Fifty-five cases with advanced pharyngolaryngeal cancer underwent one-stage operative reconstruction with pectoralis major myocutaneous flap from June 1996 to June 2004.Clinical data were reviewed. The sites were as follows: base of tongue, 19 cases; tonsil, 10 cases; laryngopharynx, 9 cases; larynx, 9 cases and nasopharynx, 8 cases. Twenty-one cases underwent preoperative radiotherapy, 25 cases with postoperative radiotherapy. Forty cases with pharyngolaryngeal mucosa and soft tissue defects and 15 cases with neck skin defects were reconstructed with pectoralis major myocutaneous flap. All 55 cases finished one-stage operative reconstruction with pectoralis major myocutaneous flap. One cases occurred total skin necroses; 3 cases, partial skin necroses of the pectoralis major myocutaneous flap. The successful reconstruction rate was 98.2% (54/55). Among 40 patients with larynpharynx mucosa defects, only 3 cases had slight cough and 1 case had swallow disability. All the cases had voice recovered except of the patients undertaken total laryngectomy. All 15 cases with neck skin defects got healing. Three-year and five-year survival rate were as follows: base of tongue cancer, 5/8, 2/5; tonsil cancer, 3/6, 2/4; laryngopharyngeal cancer, 2/4, 1/3; laryngeal cancer, 2/3, 1/2; nasopharyngeal cancer, 2/4, 1/3 respectively. Conclusion] The blood supply of pectoralis major myocutaneous flap is reliable, the tissue volume is enough for reconstruction. Pectoralis major myocutaneous flap is perfect material for one-stage operative reconstruction to the operative defects in advanced pharyngolaryngeal cancer with high successful rate and quality of life improved.