颏下动脉穿支皮瓣在咽喉癌术后缺损修复中的应用  

Application of submental artery perforator flap in reconstruction surgery in pharyngeal carcinoma

作　　者：何时知 房居高[1] 李平栋[1] 钟琦[1] 侯丽珍[1] 马泓智[1] 冯凌[1] 陈晓红[1] 时倩[1] He Shizhi;Fang Jugao;Li Pingdong;Zhong Qi;Hou Lizhen;Ma Hongzhi;Feng Ling;Chen Xiaohong;Shi Qian(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第12期1126-1130,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市自然科学基金-市教委联合资助项目(KZ201910025034);首都卫生发展科研专项项目(2018-2-2054);北京市医院管理局"登峰"人才培养计划(DFL20180202)。

摘　　要：目的:探讨颏下动脉穿支皮瓣在咽喉癌术后缺损修复中的应用及效果。方法:回顾性分析2015年1月至2019年12月,首都医科大学附属北京同仁医院收治的27例行带蒂颏下动脉穿支皮瓣一期修复的口咽癌(10例)和下咽癌(17例)患者的病历资料,其中男23例,女4例,年龄40~70岁。口咽癌中扁桃体癌5例,其中4例行颈-口联合入路扁桃体癌扩大切除术,1例行下颌骨裂开扁桃体癌切除术,舌根癌5例均行经颈外舌骨入路舌根癌切除术;下咽癌中梨状窝癌16例,均行保留喉功能的部分下咽部分喉切除术,咽后壁癌1例行部分下咽切除术。分析颏下动脉穿支皮瓣修复口咽癌及下咽癌缺损的预后、吞咽功能和喉功能恢复情况。结果:27例患者随访时间为6~66个月,中位时间13个月。1例下咽癌患者因局部复发死亡,1例下咽癌患者因食管癌死亡,1例下咽癌患者舌根复发带瘤生存,余24例患者随访期间无复发和远处转移。估算2年生存率为92.9%,3年生存率为88.9%。术后并发症方面皮瓣坏死1例次,咽瘘1例次,皮下脂肪液化和积液2例次,淋巴瘘1例次。25例患者术后成功拔除气管套管,拔管率为92.6%,其中下咽癌拔管率为16/17,口咽癌拔管率为9/10。25例成功拔除鼻饲管,完全经口进食率为92.6%。结论:颏下动脉穿支皮瓣制备成功率高,修复口咽和下咽癌术后缺损能够很好的恢复吞咽和喉功能。Objective To evaluate clinical applications and efficacy of submental artery perforator flap in reconstruction surgery after removal of pharyngeal carcinoma.Methods A total of 27 patients in the Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University were included,23 males and 4 females with age from 40 to 70 years old,and 17 patients were hypopharyngeal carcinoma(HPC)and 10 patients were oropharyngeal carcinoma(OPC).All patients underwent tumor resection followed by simultaneously reconstruction surgery using submental artery perforator flap between January 2015 and December 2019.Of 5 patients with palatine tonsil cancer,4 underwent the combined approach of neck and oral resection and 1 with madibulotomy.All 5 patients with tongue base cancer received transhyoid partial glossotomy with or without partial laryngectomy.Sixteen patients with pyriform sinus carcinoma received partial laryngo-pharyngectomy with preservation of laryngeal functions.One patient with posterior hypopharyngeal wall carcinoma had partial pharyngectomy.Prognosis and laryngeal functions were analyzed after reconstruction surgery with submental artery perforator flap in patients with pharyngeal carcinoma.Results The 27 patients were followed up for 6-66 months,with a median of 13 months,of them 24 patients were alive without recurrence or metastasis,1 patient died of recurrence,1 patient died of esophageal carcinoma and 1 patient was alive with the recurrence of tongue base carcinoma.Postoperative complications included flap failure for 1 case,pharyngeal fistula for 1 case,subcutaneous hydrops for 2 cases and lymphatic fistula for 1 case.Total 2 and 3 year survival rates were 92.9%and 88.9%,respectively.Total decanulation rate was 92.6%;decanulation rate and intubation time were 16/17 and 3.5 months in HPC patients;and decanulation rate and intubation time were 9/10 and 2 months in OPC patients.Total oral feeding rate was 92.6%and nasogastric feeding time was 3.5 weeks in HPC patients and 3 w

关 键 词：口咽肿瘤 下咽肿瘤 修复外科手术 颏下动脉穿支皮瓣 

分 类 号：R739.65[医药卫生—肿瘤] R739.63[医药卫生—临床医学]