CAJ | 학술논문

目的：探讨胸大肌肌皮瓣在合并各种手术不利因素下的晚期口咽癌手术中的应用价值。方法选择行根治性手术的晚期口咽癌患者15例，均合并各种手术不利因素（如高龄、糖尿病、心血管疾病、放疗损伤等），采用胸大肌肌皮瓣同期修复组织缺损，观察组织缺损修复效果。结果15例均顺利完成手术并安全度过围手术期。手术时间4～6 h，平均5 h。皮瓣制备时间40～55 min，平均45 min。皮瓣完全成活率93％，1例（7％）远端局部皮肤坏死，1例（7％）口咽颌下瘘，2例（13％）切口局部感染，对症治疗后均愈合。结论对于合并各种手术不利因素的晚期口咽癌患者，胸大肌肌皮瓣较游离皮瓣有更高的安全性，可作为组织缺损修复的一种挽救性手段。
목적：탐토흉대기기피판재합병각충수술불리인소하적만기구인암수술중적응용개치。방법선택행근치성수술적만기구인암환자15례，균합병각충수술불리인소（여고령、당뇨병、심혈관질병、방료손상등），채용흉대기기피판동기수복조직결손，관찰조직결손수복효과。결과15례균순리완성수술병안전도과위수술기。수술시간4～6 h，평균5 h。피판제비시간40～55 min，평균45 min。피판완전성활솔93％，1례（7％）원단국부피부배사，1례（7％）구인합하루，2례（13％）절구국부감염，대증치료후균유합。결론대우합병각충수술불리인소적만기구인암환자，흉대기기피판교유리피판유경고적안전성，가작위조직결손수복적일충만구성수단。
Objective To explore the clinical value of using pectoralis major myocutaneous flap in surgery with various adverse factors for advanced oropharyngeal cancer.Methods 15 patients who presented with advanced oropharyngeal cancer were performed for radical surgery,and pectoralis major myocutaneous flaps were applied for immediate reconstruction of surgical defect.In all cases,various adverse factors(advanced age,diabetes,cardiovascular disease,radiation damage,etc.)were existed.The effect of reconstruction was observed.Results All surgeries were successful,and all patients tided over perioperative period.The average time of operation was 5 hours with a range of 4 to 6 hours.The average time cost for flap preparation was 40 minutes with a range of 40 to 55 minutes.The completely survival rate of flaps was 93%.Partial skin necrosis occurred in 1 case(7%);and submandibular fistula occurred in another one(7%).Two patients(13%)developed wound infection.All of them were healed by symptom-atic treatment.Conclusion For the patients with advanced oropharyngeal cancer and various adverse factors of sur-gery,pectoralis major myocutaneous flap can be used as salvage measure in reconstruction of surgical defect,which is more secure than free flap.