中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
5期
378-381
,共4页
刘宏伟%李振东%董慧蕾%李树春
劉宏偉%李振東%董慧蕾%李樹春
류굉위%리진동%동혜뢰%리수춘
外科皮瓣%头颈部肿瘤%修复外科手术
外科皮瓣%頭頸部腫瘤%脩複外科手術
외과피판%두경부종류%수복외과수술
Surgical flaps%Head and neck neoplasms%Reconstructive surgical procedures
目的 总结应用游离股前外侧皮瓣修复头颈肿瘤术后缺损的临床经验.方法 回顾性分析2007年11月至2010年6月辽宁省肿瘤医院头颈外科应用游离股前外侧皮瓣修复重建头颈部恶性肿瘤术后缺损43例患者的临床资料.患者男32例,女11例;年龄40～81岁,中位年龄56岁.口腔癌23例,咽侧壁扁桃体7例,下咽癌11例,头皮癌、枕部肉瘤各1例.肿瘤分期:T1期9例,T2期17例,T3期11例,T4期6例.为保证有足够的安全切缘,所有患者手术切除范围为距肉眼所见肿瘤边缘至少2 cm,43例患者肿瘤切除术后应用游离股前外侧皮瓣进行修复重建,恢复咀嚼、吞咽及呼吸功能.皮瓣血管蒂长8～18 cm,平均12.5 cm.左股前外侧皮瓣41例,右侧2例.皮瓣面积(4～15)cm×(5～25)cm.结果 游离股前外侧皮瓣移植一期成功40例,1例术后第5天出现静脉血栓,重新吻合血管皮瓣成活.坏死3例,其中2例分别于术后第1天、第4天胸大肌肌皮瓣修复.1例第20天皮瓣坏死脱落后长肉芽愈合.11例下咽癌患者中3例行喉全切除术,8例保留喉功能(72.7%).23例口腔癌、7例咽侧壁扁桃体癌术后均恢复较好的咀嚼、吞咽、发音功能.头皮癌、枕部肉瘤患者较好地修复了大面积皮肤缺损.结论 游离股前外侧皮瓣修复技术可靠,成活率高,供区无严重并发症.皮瓣薄厚适中,可塑性好,是头颈肿瘤术后修复重建理想的修复皮瓣.
目的 總結應用遊離股前外側皮瓣脩複頭頸腫瘤術後缺損的臨床經驗.方法 迴顧性分析2007年11月至2010年6月遼寧省腫瘤醫院頭頸外科應用遊離股前外側皮瓣脩複重建頭頸部噁性腫瘤術後缺損43例患者的臨床資料.患者男32例,女11例;年齡40～81歲,中位年齡56歲.口腔癌23例,嚥側壁扁桃體7例,下嚥癌11例,頭皮癌、枕部肉瘤各1例.腫瘤分期:T1期9例,T2期17例,T3期11例,T4期6例.為保證有足夠的安全切緣,所有患者手術切除範圍為距肉眼所見腫瘤邊緣至少2 cm,43例患者腫瘤切除術後應用遊離股前外側皮瓣進行脩複重建,恢複咀嚼、吞嚥及呼吸功能.皮瓣血管蒂長8～18 cm,平均12.5 cm.左股前外側皮瓣41例,右側2例.皮瓣麵積(4～15)cm×(5～25)cm.結果 遊離股前外側皮瓣移植一期成功40例,1例術後第5天齣現靜脈血栓,重新吻閤血管皮瓣成活.壞死3例,其中2例分彆于術後第1天、第4天胸大肌肌皮瓣脩複.1例第20天皮瓣壞死脫落後長肉芽愈閤.11例下嚥癌患者中3例行喉全切除術,8例保留喉功能(72.7%).23例口腔癌、7例嚥側壁扁桃體癌術後均恢複較好的咀嚼、吞嚥、髮音功能.頭皮癌、枕部肉瘤患者較好地脩複瞭大麵積皮膚缺損.結論 遊離股前外側皮瓣脩複技術可靠,成活率高,供區無嚴重併髮癥.皮瓣薄厚適中,可塑性好,是頭頸腫瘤術後脩複重建理想的脩複皮瓣.
목적 총결응용유리고전외측피판수복두경종류술후결손적림상경험.방법 회고성분석2007년11월지2010년6월요녕성종류의원두경외과응용유리고전외측피판수복중건두경부악성종류술후결손43례환자적림상자료.환자남32례,녀11례;년령40～81세,중위년령56세.구강암23례,인측벽편도체7례,하인암11례,두피암、침부육류각1례.종류분기:T1기9례,T2기17례,T3기11례,T4기6례.위보증유족구적안전절연,소유환자수술절제범위위거육안소견종류변연지소2 cm,43례환자종류절제술후응용유리고전외측피판진행수복중건,회복저작、탄인급호흡공능.피판혈관체장8～18 cm,평균12.5 cm.좌고전외측피판41례,우측2례.피판면적(4～15)cm×(5～25)cm.결과 유리고전외측피판이식일기성공40례,1례술후제5천출현정맥혈전,중신문합혈관피판성활.배사3례,기중2례분별우술후제1천、제4천흉대기기피판수복.1례제20천피판배사탈락후장육아유합.11례하인암환자중3례행후전절제술,8례보류후공능(72.7%).23례구강암、7례인측벽편도체암술후균회복교호적저작、탄인、발음공능.두피암、침부육류환자교호지수복료대면적피부결손.결론 유리고전외측피판수복기술가고,성활솔고,공구무엄중병발증.피판박후괄중,가소성호,시두경종류술후수복중건이상적수복피판.
Objective To evaluate the results of reconstruction by free anterolateral thigh flaps ( ALT) after operation of head and neck tumors. Methods Forty-three cases underwent the reconstruction of postoperative defects with free anterolateral thigh flaps after head and neck cancer surgeries between November 2007 and June 2010 were reviewed. Ages of the patients ranged from 40 to 81 years, with a median of 56 years; 32 males and 11 females; 23 cases of oral carcinoma, 7 cases of tonsil carcinoma, 11 cases of hypopharyngeal carcinoma,and 2 cases of head skin cancer. TNM classified as follows; no case of distant metastasis; T1 9 cases; T2 17 cases; T3 11 cases; T4 6 cases. All patients were applied with ALT to restore swallowing and respiratory functions. The mean length of blood vessel pedicles of the ALT free flaps was 12. 5 (8-18) cm. The flaps were 4 - 15 cm in width,5 - 25 cm in length. Results In the 43 cases applied with ALT free flaps, 40 cases were successful and 3 cases unsuccessful. Two of the failed cases were reconstructed with pectoralis major flap. In 11 cases of hypopharyngeal carcinoma, except 3 cases with total laryngectomy, 8 cases(72. 7% ) had their laryngeal function been preserved. Conclusions The successful rate of ALT free flaps is perfect. There were no serious complication in offered areas. The flap could be shaped into various forms. ALT free flap is an ideal flap to reconstruct the defect after surgery in some head and neck tumors.
