头颈肿瘤术中气管缺损的修复重建  

Trachea defect reconstruction in head and neck neoplasm operation

作　　者：陈立[1] 黄琦[1] 吴皓[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科,上海200092

出　　处：《现代肿瘤医学》2010年第12期2343-2345,共3页Journal of Modern Oncology

摘　　要：目的:探讨头颈部肿瘤术中造成气管缺损的修复重建方法及临床疗效。方法:对10例造成气管缺损的修复重建方法进行回顾性总结。其中,气管腺样囊性癌3例,甲状腺癌6例,喉复发癌1例。气管环全层缺损7例,气管前壁缺损3例,气管膜部(含前壁缺损)1例。结果:气管端端吻合7例,胸锁乳突肌锁骨肌骨膜瓣修复气管前壁及部份侧壁缺损2例,胸大肌肌皮瓣修复膜部,胸锁乳突肌锁骨肌骨瓣修复气管前壁缺损1例。随访1.0-5.0年,均存活。8例均能拔除气管套管,2例因双侧喉返神经切除者未能拔管。均有较好的发音功能。结论:按肿瘤外科原则切除头颈部肿瘤及受侵气管的同时可造成气管缺损,术中选用气管壁的部分缺损可用胸锁乳突肌锁骨肌骨(膜)瓣修复,膜部的缺损可用胸大肌皮瓣修复,环周缺损可用气管端端吻合修复;可提高病人的生存率和生存质量。Objective：To review the effect of tracheal effect reconstruction in head and neck neoplasm patients treated with different methods.Methods：Data of ten head and neck neoplasm patients whose tracheal defects reconstructed with different methods were reviewed retrospectively,their diagnosis were trachea adenoid cystic carcinoma 3 cases,thyroid carcinoma 6 cases,and recurred laryngeal carcinoma 1 case.The defects were trachea ring defect in 7 cases,front-wall and partial lateral wall defect of trachea in 2 cases and membrane part defect（including front-wall） of trachea in 1 case.The methods of trachea reconstruction were end-to-end anastomosis in 7 cases,myo periosteal flap of sternocleidomastoideus muscle attached with clavicular periosteum flap were used to repair the anterior wall defect of trachea in 2 cases and combined myocutaneous flap of pectorialis major and myo-periosteal flap of sternocleidomastoideus muscle for reconstructing defects of membranous portion of trachea and the larynx respectively in 1 case.Results：The patients have been followed up from 1 to 5 years.All the transplants were survived well with no local recurrence.Eight patients can speak without tracheal cannula while the other two patients with bilateral recurrent laryngeal nerves resected can speak with tracheal cannula.Conclusion：According to surgical principle for malignant tumor,the whole neoplasm should be excised enbloc with the invaded trachea.The resulting tracheal defects created on anterior or lateral tracheal wall can be reconstructed by myo-periosteal flap of sternocleidomastoideus and clavicular priosteum.The membrane portion defect can be reconstructed by myocutanous flap of pectoralis major.In case of total tracheal ring defect,direct anastomosis of trachea is valid.These reconstructions can enhance patient＇s survival rate and llfe quality.

关 键 词：头颈部肿瘤 气管 外科皮瓣 显微外科手术 

分 类 号：R739.91[医药卫生—肿瘤]