游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效观察  

Clinical application of free thoracoacromial artery perforator flap in reconstruction of tongue and mouth floor defects after resection of tongue carcinoma

作　　者：宋达疆[1] 李赞[1] 周晓[1] 章一新[2] 谢松林[3] 彭小伟[1] 周波[1] 吕春柳[1] 杨丽嫦[1] 彭文[1] 

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整复外科,上海200011 [3]南华大学附属南华医院手足外科,湖南衡阳421000

出　　处：《中国修复重建外科杂志》2017年第2期222-226,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省自然科学基金面上项目(13JJ5012);湖南省科技计划项目(2014SK3002);湖南省卫计委课题项目(B2014-111)~~

摘　　要：目的探讨游离胸肩峰动脉穿支皮瓣修复舌癌术后缺损的疗效。方法2010年5月—2015年2月,采用游离胸肩峰动脉穿支皮瓣移植修复11例舌癌术后缺损并行舌再造。男9例,女2例;年龄33~72岁,平均52.6岁。均为鳞状细胞癌;原发舌缘7例,原发舌腹2例,口底癌累及舌2例。根据国际抗癌联盟(UICC)TNM分期:T4N0M03例,T4N l M03例,T3N1M02例,T3N2M02例,T3N0M01例。病程3~28个月,平均10.6个月。肿瘤范围6 cm×3 cm^10 cm×5 cm。术中穿支皮瓣切取范围为7.0 cm×4.0 cm^11.0 cm×5.5 cm;厚度0.6~1.2 cm,平均0.8 cm;血管蒂长6.8~9.9 cm,平均7.2 cm。结果术后11例皮瓣均顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。患者均获随访,随访时间12~24个月,平均17.2个月。患者再造舌外形良好,吞咽及语言功能满意,随访期间肿瘤局部无复发。供区仅遗留线性瘢痕,胸大肌功能未见明显影响。结论胸肩峰动脉穿支皮瓣质地好,再造舌外形及功能良好,供区损伤小,是舌癌术后舌缺损修复与舌再造的理想选择。Objective To investigate the clinical outcome of free thoracoacromial artery perforator （TAAP） flap in the reconstruction of tongue and mouth floor defects after radical resection of tongue carcinoma. Methods Between May 2010 and February 2015, 11 cases of tongue carcinoma underwent radical resection and reconstruction of tongue and mouth floor defects with free TAAP flaps. The locations of tongue carcinoma were the lingual margin in 7 cases, the ventral tongue in 2 cases, and the mouth floor in 2 cases. According to Union for International Cancer Control （UICC） TNM stage, 3 cases were classified as T4N0M0, 3 cases as T4N1M0, 2 cases as T3N1M0, 2 cases as T3N2M0, and 1 case as T3N0M0. The disease duration ranged from 3 to 28 months, 10.6 months on average. The tumor size ranged from 6.0 cm× 3 cm to 10 cm×5 cm. The TAAP flap ranged from 7.0 cm×4.0 cm to 11.0 cm×5.5 cm in size, and 0.6-1.2 cm （0.8 cm on average） in thickness, with a pedicle length of 6.8-9.9 cm （7.2 cm on average）. Results All 11 flaps survived, the donor site was closed directly and healed primarily in all cases. The patients were followed up 12-24 months （17.2 months on average）. The reconstructed tongue had satisfactory appearance and good functions of swallowing and language. No local recurrence was observed during follow-up. Only linear scar was left at the donor site, and the function of pectoralis major muscle was normal. Condusion The TAAP flap is an ideal choice in the reconstruction of tongue defect after resection of tongue carcinoma, which has good texture, appearance, and function results.

关 键 词：胸肩峰动脉穿支皮瓣 游离皮瓣 舌肿瘤 舌再造 

分 类 号：R739.86[医药卫生—肿瘤]