晚期扁桃体鳞状细胞癌的综合治疗及胸大肌肌皮瓣一期修复缺损  

Combined therapy of advanced tonsillar squamous cell carcinoma and one-stage repair of the defect

作　　者：肖文惠[1] 易自翔[1] 

机构地区：[1]福建医科大学附属第一医院耳鼻咽喉科,福州350005

出　　处：《中华耳鼻咽喉科杂志》2002年第1期41-43,共3页Chinese Journal of Otorhinolaryngology

摘　　要：目的　探讨晚期扁桃体癌有效的治疗方法。方法　 1991年以来福建医科大学附属第一医院耳鼻咽喉科采用口腔下颌骨升支联合径路切除扁桃体癌 ,胸大肌肌皮瓣一期修复缺损 ,并加功能性颈淋巴结清扫术 ,配合术前化学治疗和术后放射治疗 ,治疗晚期扁桃体鳞状细胞癌 8例。结果　全部病例随访 3～ 9年 ,6例存活 3年以上 ,存活率 6 / 8;2例死亡 ,1例于术后 3个月死于放射性下颌骨骨髓炎大出血 ,1例术后 2年死于食管癌。并发症 :放射性下颌骨骨髓炎 2例 ,术后短暂食物返流入鼻腔 2例。结论　口腔下颌骨升支联合径路 ,可于直视下在肿瘤外 1 0cm的边界范围内安全地将肿瘤完整大块切除。配合功能性颈淋巴结清扫术、术前化学治疗和术后放射治疗 ,对减少肿瘤复发、提高疗效具有重要意义。胸大肌肌皮瓣具有取材方便 ,肌皮瓣成活率高 。Objective To evaluate the treatment of advanced squamous cell carcinoma of the tonsil. Methods Eight patients with advanced tonsillar carcinoma underwent resections combining mandibular ramus and oral cavity approaches, neck dissection and one-stage repair of the defect with pectoralis major myocutaneous flap (PM). The managements were supplemented with preoperative chemotherapy and postoperative radiotherapy. Results Following up 3 to 9 years, 6 of 8 cases(75%) survived for more than 3 years. Two of 8 cases (25%)died of different causes postoperatively. One case died of serious hemorrhage resulted from radio-mandibulomyelitis 3 months after operation, and the other case died of esophageal carcinoma 2 years after operation. Two cases complicated radio-mandibulomyelitis. Two cases suffered from temporary regurgitation of food to the nasal chamber. Conclusions Through this combined approach, the advanced tonsillar carcinoma could be resected en bloc under direct visual field and keeping 1～1.5 cm safe margin to the tumor. Neck dissection, preoperative chemotherapy and postoperative radiotherapy were supplemental measures. Combined therapy was of great significance in reducing recurrence of the tumor. PM was usually survived and easily obtained, hence, suitable for repairing the pharyngeal defect.

关 键 词：扁桃体肿瘤 鳞状细胞癌 外科皮瓣 下颌修复术 综合治疗 

分 类 号：R739.63[医药卫生—肿瘤]