颊癌口咽癌切除术后局部带蒂组织瓣修复65例

目的：组织瓣修复缺损是头颈部肿瘤切除术中的重要手段和必要环节。本研究总结65例颊癌和口咽癌不同范围组织缺损用局部带蒂组织瓣的修复方法。方法：回顾2001～2009年我科65例口腔颊癌及口咽癌切除术后选择腭瓣、颏下瓣、面动脉逆行皮瓣、颊脂垫颊肌复合瓣修复颊部及口咽部组织缺损,病变范围和治疗结果。结果：65例皮瓣中,17例腭瓣全部成活,29例颏下瓣26例全部成活,2例部分坏死,1例表层皮肤坏死,7例面动脉逆行皮瓣6例全部成活,1例坏死,12例颊脂垫或颊脂垫颊肌复合瓣全部成活11例,1例部分坏死,总成活率96.9%。31例患者术后有不同程度的张口受限,咀嚼和吞咽功能基本正常。结论：根据颊癌和口咽癌的病变范围决定采用不同的临近带蒂组织瓣修复缺损,修复效果确切,可以明显减少手术创伤和术后并发症,尤其适用于年老及较多基础疾病患者,仍应作为头颈部肿瘤术后缺损修复的重要方法。

Reconstruction of Tissue Defects Resulting from Buccal or Oropharyngeal Carcinoma Ablation with Regional Pedicular Flaps in 65 Cases

Objective：To reconstruct the defects with flaps is the important modality and indispensable step during the process of tumor resection in the head and neck surgery.This study reviewed reconstructive methods with regional pedicular flap in repairing defects resulting from buccal and oropharyngeal carcinoma of 65 cases.Methods：To retrospect 65 cases of reconstruction of defects resulting from resection of buccal or oropharyngeal carcinoma with various pedicular flaps such as palatal flap,submental flap,reversed facial artery flap etc,TNM stage of disease,and results.Results：Of all 65 cases,17 cases of palatal flap survived good enough without failure,27 out of 29 cases of mental flap survived,the other 2 cases experienced partial necrosis,6 out of 7 cases of reversed facial artery flap survived while one case suffered from total necrosis,11 out of 12 cases buccal fat or combination of buccal fat and buccal musculature survived while one of which experienced partial necrosis.The total survival rate reached 96.9%.31 cases experienced slight limited opening of mouth but almost normal during swallowing and mastication.Conclusion：To reconstruct defects resuting from resection of buccal or oropharyngeal carcinoma with regional pedicular flap has good results when indicated,could eliminate iatrogenic injury and postoperative complications,thus is best suited for old or compromised patients with general disease and should serve as an important method for reconstruction of defects from head and neck tumor surgery.