外科术后进行或不进行放疗的头颈部缺损显微重建策略探讨  

Surgical strategies to secondary head neck reconstruction after previous operations with or without radiotherapy

作　　者：徐中飞[1] 段维轶[1] 白爽[1] 田雨[1] 谭学新[1] 孙长伏[1] 刘法昱[1] 代炜[1] 

机构地区：[1]中国医科大学口腔医学院口腔颌面-头颈肿瘤外科,口腔颌面外科教研室,辽宁省口腔医学研究所,辽宁省口腔疾病转化医学研究中心,辽宁省口腔疾病重点实验室,辽宁沈阳110002

出　　处：《中国口腔颌面外科杂志》2016年第1期39-43,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：辽宁省教育厅科研基金(L2014317);辽宁省自然科学基金(2014021096);国家临床重点专科项目

摘　　要：目的:总结外科术后伴或不伴放疗的头颈部缺损显微重建的基本策略。方法:回顾2012年1月—2014年12月中国医科大学附属口腔医院口腔颌面外科采用游离皮瓣重建肿瘤根治术后伴或不伴放疗的头颈部缺损病例13例,统计相关临床资料并进行总结。结果:13例患者中,12例曾接受肿瘤根治术及选择性颈淋巴清扫(levelⅠ-Ⅲ),其中11例术后进行放射治疗。恶性肿瘤术后复发9例,恶性肿瘤再发2例,上颌骨切除术后开口受限1例,另1例为鼻咽癌放疗后下颌骨骨髓炎。所有病例均采用游离皮瓣进行重建(股前外侧皮瓣7例,股前内侧皮瓣1例,前臂皮瓣1例,腓骨瓣2例,股前外侧皮瓣+股前内侧皮瓣2例);受区血管采用同侧颈横血管10例,对侧颈部血管2例,颞浅血管1例。皮瓣完全成活且无明显并发症。平均随访时间17个月,1例死于远处转移,1例死于局部复发。结论:对于外科术后伴或不伴放疗的需要游离皮瓣重建的病例,同侧颈横血管可能是首选的受区血管;颈横静脉如不可用,可选择颈内静脉或颈外静脉作为备选。如颈横血管系统都不可用,对侧颈部血管和颞浅血管也是有益的补充。PURPOSE： To discuss the surgical strategies to secondary free tissue transfer after previous operations with or without radiotherapy in head and neck reconstruction. METHODS： Between January 2012 and December 2014, secondary head and neck reconstruction was performed in 13 patients who had undergone previous neck dissection （n=12） and radiation therapy （n=1 1）. All secondary defects were reconstructed with free flaps. Clinical data were recorded for each patient. RESULTS： Nine patients had a recurrent carcinoma, two had a secondary primary cancer, one had undergone an operation for scar release and one had an osteoradionecrosis of mandible after radiotherapy for nasopharyngeal carcinoma. All free flaps survived well and the patients healed without major complications. Anterolateral thigh flap （ALT, n=7）, anteromedial thigh flap （AMT, n=1）, radial forearm free flap （n=1）, fibular flap （n=2） and ALT＋AMT flaps （n=2） were used for reconstruction. Transverse cervical vessels （TCVs, n=10）, vessels of contra-lateral neck （n=2） and superficial temporal vessels （STV, n=1） were chosen as recipient vessels. The mean follow-up time was 11 months. One patient died of distant metastases and 1 died of local recurrence during follow-up. CONCLUSIONS： In patients who had previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and accessible recipient vessels for microsurgical reconstruction in the head and neck region. If the TCVs are unavailable, the STVs and the vessels of contra-lateral neck can serve as an alternative for microvascular anastomosis. Additionally, the internal or external jugular vein should be dissected carefully to avoid vein grafting.

关 键 词：头颈部 游离皮瓣 显微重建 血管缺乏性颈部 放疗 颈横血管 

分 类 号：R739.91[医药卫生—肿瘤]