经下颌骨裂开外旋入路切除扁桃体癌术后组织缺损的修复  

Reconstruction of tissue defects after resection of tonsillar cancer by mandibular swing approach

作　　者：程磊[1] 吴海涛[1] 陶磊[1] 李筱明[1] 周梁[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第6期415-419,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨经下颌骨裂开外旋切除扁桃体癌术后组织的缺损修复方法。方法:把24例扁桃体癌术后缺损分成3类:①小缺损8例,分别为扁桃体窝或(和)咽弓等咽侧缺损,其中4例采用中厚皮片修复,另外4例则采用前臂桡侧皮瓣进行修复;②中缺损5例,除咽侧缺损外,同时伴软腭或舌根小缺损,采用前臂桡侧皮瓣修复2例,股前外侧瓣修复3例;③大缺损11例,除咽侧缺损外,同时伴软腭和舌根大缺损,采用股前外侧瓣修复2例,胸大肌皮瓣修复9例。结果:24例扁桃体癌修复术后创面均一期愈合。4例皮片全部成活,6例前臂桡侧皮瓣修复术后缺损中,有1例前臂皮瓣于修复术后5d出现血管危象失败,后经口腔和颌下取出坏死皮瓣,创面自行愈合。另5例前臂桡侧皮瓣和5例股前外侧瓣全部存活。9例胸大肌皮瓣修复术后组织缺损,手术创面全部一期愈合,修复部位虽出现臃肿,但半年后明显减轻。有软腭侵犯的患者修复术后,1例出现轻微流质鼻腔返流,3例患者术后讲话含糊,但能听懂,其他患者的咀嚼、吞咽、呼吸、语言功能恢复良好。结论:T2扁桃体癌切除术后咽侧小缺损可用中厚皮片或前臂皮瓣修复;T2、T3扁桃体癌的咽侧加软腭或舌根小缺损,可用前臂或股前外侧瓣修复;T3及以上扁桃体癌的咽侧加软腭及舌根大缺损,可采用股前外侧瓣或胸大肌皮瓣修复。Objective：To explore the reconstruction methods of oropharyngeal defects after resection of tonsillar cancer by mandibular swing approach.Method：Twenty-four cases of patients with tonsillar carcinoma hospitalized in our institution from January,2010 to December,2015 were analyzed.Based on the degree and extent of tissue defects,they were divided into three categories.①Small defects,including loss of tonsillar fossa and pharyngeal arches;②Moderate defects,including small defects of soft palate or tongue root besides lateropharyngeal defects;③Large defects,including large defects of soft palate and tongue root besides lateropharyngeal defects.The tissue defects of 8patients belonged to small defects,of whom 4cases were repaired with mid-thick skin and the others were restored by radial forearm flaps.There were 5cases of patients with moderate oropharyngeal defects after surgery of tonsillar carcinoma.These defects were reconstructed by radial forearm flaps（2cases）and anterolateral femoral skin flaps（3cases）respectively,while the remaining large defects of 11 patients were renovated using pectoralis major myocutaneous flaps（9cases）and anterolateral femoral skin flaps（2cases）.Result：All the patients healed by first intention after surgery.Four transplanted skin grafts on the regions of small defects survived completely.5cases of radial forearm flaps and anterolateral femoral skin flaps also survived well,whereas only one radial forearm flap suffered from vascular crisis leading to failure at 5days postoperatively.The necrotic flaps were then removed by submaxillary space and oral cavity and the wounds were self-healed.The tissue defects were successfully repaired by pectoralis major myocutaneous flaps.Although the surgical wounds swelled,they were obviously relieved half a year later.In the tonsillar cancer patients encroached on soft palates,one occurred nasopharyngeal reflux and 3spoke vaguely but understandably.The other patients＇ function of chewing,deglutition,respiration and speech

关 键 词：扁桃体癌 皮瓣 修复 

分 类 号：R766.18[医药卫生—耳鼻咽喉科]