侧斜方肌肌皮瓣修复头颈肿瘤术后缺损的初步探索

目的探索侧斜方肌肌皮瓣在头颈肿瘤术后缺损中的作用及其优缺点。方法自2005年6月至2006年6月共采用带蒂侧斜方肌肌皮瓣移植修复头颈肿瘤术后缺损6例,其中舌根癌3例,鼻咽癌放疗后颈淋巴结复发累及皮肤3例,观察肌皮瓣的存活情况、组织移植后功能状态和肿瘤控制的近期疗效。结果全部肌皮瓣存活,无手术并发症,舌根缺损修复后进食、咀嚼、发音均满意,颈部缺损修复后外形满意,无垂肩畸形;全部病例随访6～18个月,1例舌根癌术后6个月死于肿瘤复发,1例鼻咽癌放疗后复发者术后6个月复发,挽救治疗中,其余4例均无瘤生存至今。结论侧斜方肌肌皮瓣可以安全地应用于舌根、颈部缺损修复;手术方便,对供区影响小是该皮瓣的优点;颈横静脉缺如偶有存在,确保充足的静脉回流是手术成功的关键。

Application of Lateral Trapezius Myocutanoeus Flap in Reconstruction of Defect after Ablation of Head and Neck Cancer

Objective This study was designed to explore the role of lateral trapezius myocutaneus flap administered in reconstruction of the defect after ablation of head and neck cancer.Methods From Jun.2005 through Jun.2006,lateral trapezius myocutaneus flap were administered in reconstruction of the surgical defect after ablation of the head and neck cancer,including 3 cases with carcinoma of the base of the tongue and the other 3 cases suffered from cervical recurrence after radiation for nasopharyngeal carcinoma with involvement of the overlying skin.Survival and functional outcome of the flap as well as tumor control were observed.Results All 6 flaps survived after operation without complication.Phonation and swallowing were well after operation in 3 cases with carcinoma of the base of the tongue.Morphologic and functional outcome of the shoulder were well in 3 cases with cervical recurrence after radiation of nasopharyngeal carcinoma.All 6 cases followed up for 6 to 18 months.4 cases were free from tumor.1 case died from recurrence of the primary cancer and 1 case suffered from tumor recurrence 6 months after operation.Conclusion Lateral trapezius myocutaneus flap can safely be used in reconstruction of the surgical defect of the base of the tongue and that of the neck,with convenient surgical procedure and less impact to the donor site.In the cases with absence of the transcervical vien,ensure of the blood refluence is the key for survive of the flap.