半侧舌根组织瓣在咽腔侧方缺损修复中的应用

目的 探讨下咽癌切除后应用半侧舌根组织瓣修复咽腔侧方缺损的效果。 方法 回顾性分析 2014年10月~2016年4月于山东大学齐鲁医院(青岛)行下咽癌切除并同期行半侧舌根组织瓣修补咽腔侧方缺损患者36例,其中梨状窝癌29例,下咽后壁癌7例,肿瘤均累及咽腔侧方。临床分期:Ⅱ期3例,Ⅲ期7例,ⅣA期25例,ⅣB期1例。统计并分析患者3年生存率、术后并发症发生率、咽喉功能恢复情况及喉功能保留率。 结果 所有患者肿瘤完整切除,病理示切缘阴性,均保留喉功能,吞咽、吞咽保护功能好(均于术后10~14 d拔除鼻饲管,顺利经口进食)。其中34例患者顺利拔除气管套管,气管套管拔除率94.4%。术后咽瘘发生1例,经短期换药后愈合,咽瘘发生率2.8%。36例患者3年生存率69.4%。 结论 半侧舌根组织瓣就近取材,操作简便,咽瘘发生率低,在咽腔侧方缺损修复中符合解剖及功能重建的要求。

Application of the hemi-tongue root flap for the repair of lateral defects in the pharyngeal cavity

Objective To investigate the effect of repairing lateral defects of the pharyngeal cavity caused after resection of hypopharyngeal carcinoma by using the hemi-tongue flap. Methods A retrospective analysis was performed to evaluate 36 cases of hypopharyngeal carcinoma who had undergone complete tumor resection and were simultaneously treated for hypopharyngeal wall defects in the Qilu Hospital of Shandong University(Qingdao)from October 2014 to April 2016. The cohort included 29 cases of cancer of the piriform fossa and 7 cases of cancer of the posterior pharyngeal wall. The lateral pharyngeal wall was entirely invaded by the tumor. On performing a clinical staging, 3 cases were of stage Ⅱ, 7 of stage Ⅲ, 25 of stage ⅣA, and 1 of stage ⅣB. Three-year survival rate, postoperative complication rate, recovery of throat function, and retention of laryngeal function were analyzed. Results All cases had negative pathologic incisions, and all patients retained laryngeal function, with good swallowing and swallowing protective functions(the nasogastric feeding tube was removed 10 to 14 days after surgery, and oral feeding was smooth). Tracheal cannula was successfully removed in 34 patients, with a removal rate of 94.4%. Postoperative pharyngeal fistula occurred in 1 case, which was healed after short-term dressing, so the incidence of pharyngeal fistula was 2.8%. The above 36 patients had a 3-year survival rate of 69.4%. Conclusion The hemi-tongue root flap is close to the site of pathology, easy to maneuver, and leads to a lesser incidence of pharyngeal fistula. It fulfils the requirements of anatomical and functional reconstruction in the repair of lateral pharyngeal defects.