胸大肌肌皮瓣修复晚期舌根癌术后缺损的疗效  

Pectoralis Major Myocutaneous Flap for Reconstruction of Defects after Surgery for Advanced Tongue Base Cancer

作　　者：周志田[1] 吕晓智[2] 

机构地区：[1]武警江西省消防总队医院口腔科,南昌330025 [2]南方医科大学附属南方医院口腔医院口腔-头颈外科,广州510515

出　　处：《南昌大学学报（医学版）》2014年第11期24-26,39,共4页Journal of Nanchang University：Medical Sciences

基　　金：广东省自然科学基金(S2011010003852);广东省科技计划(2012B031800139);广东省医学科研基金(A2012362)

摘　　要：目的探讨胸大肌肌皮瓣修复晚期舌根癌术后缺损的临床效果。方法回顾性分析2006年8月至2013年12月在南方医科大学附属南方医院口腔医院住院治疗的行带蒂胸大肌肌皮瓣修复20例舌根癌术后局部缺损患者的临床资料。观察20例患者术后6个月舌体外形、语音及口咽功能恢复情况,并对20例患者术前、术后6个月功能恢复进行评分(采用华盛顿大学生存质量问卷表评分)。结果 20例患者中,19例术后肌皮瓣均成活,切口Ⅰ期愈合;1例切口二期愈合。20例供区切口均Ⅰ期愈合。行放疗后,患者皮瓣均未出现坏死。20例患者术后6个月舌体外形、语音及口咽功能恢复满意。16例语音清晰;4例语音不清晰,但不影响交流,经过语音功能训练后,均达到语音清晰。20例患者术后6个月活力、咀嚼、味觉、唾液和肩功能得分与术前比较差异均无统计学意义(P>0.05),而疼痛、外貌、娱乐、吞咽、语言、情绪和焦虑得分均明显高于术前(均P<0.05)。结论采用胸大肌皮瓣进行修复和重建晚期舌根癌术后缺损,可获得良好的功能和整体生存质量。Objective To investigate the clinical efficacy of pectoralis major myocutaneous flap for the reconstruction of defects after surgery for advanced tongue base cancer（PMMF）.Methods Clinical data of 20 patients with PMMF who underwent the reconstruction of postoperative defects with pectoralis major myocutaneous flap in the Stomatological Hospital of Nanfang Hospital Affiliated to Southern Medical University between August 2006 and December 2013 were analyzed retrospectively.The tongue body shape,phonation and oropharyngeal function were observed 6months after operation.In addition,the quality of life of patients was assessed using the University of Washington Quality of Life questionnaire before and 6months after operation.Results Among the 20 patients,flaps survived and incisions healed by first intention in 19,and incisions healed by second intention in 1.All donor site incisions healed by first intention.No flap necrosis occurred in all patients after radiotherapy.Furthermore,all patients had satisfactory tongue body shape,phonation and oropharyngeal function 6months after operation.Moreover,16 patients had clear phonation,and 4patients had unclear phonation which did not affect the communication.However,the 4patients achieved clear phonation after phonation training.There were no significant differences in the vitality,chew,gustation,saliva and shoulder function scores before operation and 6 months after operation（P〉0.05）.Compared with preoperative scores,the pain,appearance,entertainment,swallowing,language,emotion and anxiety scores significantly increased 6months after operation（P〈0.05）.Conclusion The reconstruction of postoperative defects with pectoralis major myocutaneous flap can restore the swallowing and speech function and improve the quality of life in patients with PMMF.

关 键 词：舌根癌 胸大肌肌皮瓣 生存质量 

分 类 号：R739.8[医药卫生—肿瘤]