中晚期舌根癌手术缺损的修复重建  

Repair surgical defect of squamous cell carcinoma of tongue base with advanced patients

作　　者：蔡谦[1] 彭解人[1] 关中[1] 梁发雅[1] 韩萍[1] 陈仁辉[1] 黄晓明[1] 

机构地区：[1]中山大学附属孙逸仙纪念医院耳鼻咽喉头颈外科,广州510120

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第17期1510-1513,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨中晚期舌根癌手术缺损的重建方法。方法：以30例中晚期舌根鳞状细胞癌患者为研究对象，T2N1Mo4例，T3N1M0 7例，T3N2M0 10例，T4N1M0 4例，T4N2M0 5例。原发灶手术方法：舌骨咽侧切开入路12例，下颌骨正中切开入路18例。全部病例均于术后4～6周放疗。结果：带蒂胸大肌肌皮瓣修复25例，所有肌皮瓣均成活，其中1例口内皮瓣与周围组织部分分离，1例肌皮瓣局部组织坏死，均经局部换药后愈合。游离股前外侧肌皮瓣修复5例，有1例肌皮瓣局部组织坏死，经口清除坏死组织至新鲜创面，二期愈合。18例保喉患者全部拔管。3年生存率为68％，局部控制率为87％。结论：胸大肌肌皮瓣和股前外侧肌皮瓣是舌根修复可选用的供区组织。最有效和可靠的重建方法应首选胸大肌肌皮瓣，股前外侧肌游离皮瓣供区隐蔽，也是一种有效的修复手段，但需要熟练的显微手术技术。Objective： To repair the postoperative tissue defect of the base of tongue cancer in advanced pa- tients. Method：There were 30 patients of medium-high differentiation squamous cell carcinoma（SCC） included in this study. According to the TNM staging of AJCC 2002,there were 4 cases of T2N1M0, 7 of T3N1M0, 10 of T3 N2 M0, 4 of T4 N1 M0 and 5 of T4 N2 M0. Surgical approach of the primary lesion： 12 with transhyoidpharyngoto- my approach and 18 with mandibulotomy approach. All cases accepted radiotherapy 4-- 6 weeks after surgery. Result：Twenty-five cases were reconstructed with pedicle pectoralis major myocutaneous flaps, and all them sur- vived. Among them,1 flap was partial split with surrounding tissue spontaneously, and another flap had partial tissue necrosis, however,both flaps grew well with dressing and other local treatment. Other 5 cases were recon- structed with free anterolateral myocutaneous flaps. Among them, 1 flap had partial tissue necrosis, but had asecondary healing after removing necrotic tissue via mouth approach. All 18 patients of larynx-preservation had tracheal tube pulled out. The 3-year survival rate was 68 % and the local control rate was 87 %. Conclusion： Pedicle pectoralis major myocutaneous flaps and free anterolateral myocutaneous flaps were alternative donor area for re- pairing postoperative tissue defect of the base of tongues The former was preferred,and the latter was concealed so as to be a kind of effective method, which need adept technique of microsurgery.

关 键 词：舌根 鳞状细胞癌 手术 修复 

分 类 号：R739.6[医药卫生—肿瘤]