胸大肌肌皮瓣在口咽癌术后组织缺损重建中的应用价值  

The application of pectoralis major myocutaneous flap in reconstruction of surgical defect for oropharyngeal ;cancer

作　　者：莫康楠[1] 赵坚强[1] 王可敬[1] 

机构地区：[1]浙江省肿瘤医院头颈肿瘤外科,浙江省杭州,310022

出　　处：《中国基层医药》2015年第21期3204-3206,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：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。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.

关 键 词：肌皮瓣 胸大肌 口咽肿瘤 修复外科手术 

分 类 号：R739.63[医药卫生—肿瘤]