上臂外侧皮瓣在口咽癌切除后口咽缺损修复中的应用  

Application of lateral upper arm flap in the reconstruction of oropharyngeal defect after resection of oropharyngeal cancer

作　　者：许洪波[1] 李立锋[1] 周晶[1] 陈学军[1] 齐欣萌 陈晓红[1] 黄志刚[1] XU Hongbo;LI Lifeng;ZHOU Jing;CHEN Xuejun;QI Xinmeng;CHEN Xiaohong;HUANG Zhigang(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Bejing,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,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730

出　　处：《中国耳鼻咽喉头颈外科》2023年第5期273-277,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金项目(82071032)。

摘　　要：目的 探讨上臂外侧皮瓣在口咽癌切除后口咽部缺损修复中的应用。方法 回顾2020年5月~2022年10月首都医科大学附属北京同仁医院经治的10例口咽癌患者,6例人乳头状瘤病毒(HPV)相关口咽鳞状细胞癌,3例非HPV相关口咽鳞状细胞癌,1例为黏液表皮样癌。原发灶同时累及舌根、扁桃体、咽弓3例,同时累及扁桃体、软腭2例,累及舌根、扁桃体、会厌1例,同时累及扁桃体、舌根、咽弓及会厌舌面1例,同时累及舌根、杓会厌皱襞及会厌1例,同时累及扁桃体、舌根、软腭及后磨牙三角区1例,仅舌根受累1例。患者行经口联合经咽旁间隙入路口咽癌扩大切除术,切除后舌根、声门上、扁桃体等多部位缺损,采用游离上臂外侧皮瓣进行修复,分析上臂皮瓣的大小、血管蒂长度及血管直径,评估围手术期并发症,吞咽、呼吸及言语等功能恢复情况。结果 10例上臂外侧皮瓣均成活,无坏死。皮瓣大小(6×8)cm^(2)-(6×15)cm^(2),血管蒂长度为6~8 cm,上臂皮瓣动脉的直径为1~2.5 mm,回流优势静脉直径为1.5~3.0 mm。所有患者只吻合1支静脉,8例为面静脉,2例为颈外静脉。术后14~45 d拔除胃管后经口进食。6例行术后放疗,剂量60~66 Gy,放疗后7~240 d拔除气管套管。4例不需放疗者,术后14~34 d拔除气管套管。患者吞咽、呼吸及言语功能恢复良好,除2例患者上臂供区出现皮肤麻木,术后3~4周麻木感消失外,其余患者供区无功能异常。结论 上臂外侧皮瓣柔软、厚薄适中、易塑形、少有毛发,是修复口咽部缺损的理想皮瓣。OBJECTIVE To explore the application of lateral upper arm flap in the reconstruction of oropharyngeal defect after resection of oropharyngeal carcinoma.METHODS Ten cases with oropharyngeal cancer treated from May 2020 to October 2022 were studied,including 6 cases of HPV-related oropharyngeal squamous cell carcinoma(OSCC),3 cases of non-HPV-related OSCC and 1 case of mucoepidermoid carcinoma.The primary lesion involved tongue base,tonsil,oropharygeal pillars simultaneously in 3 cases,tonsil and soft palate were simultaneously involved in 2 cases,tongue base,tonsil and epiglottis were involved in 1 case,tonsil,tongue base,oropharygeal pillars and lingual surface of epiglottis were involved in 1 case,tongue base,aryepiglottic fold and epiglottis were involved in 1 case,and 1 case involved tonsil,tongue base,soft palate and trigone at the same time.The lesion of the last case was located in tongue base only.All patients underwent expanded resection of OsCC by transoral and trans-parapharyngeal space approach.Multiple defects of the tongue base,supraglottis,tonsil and other parts of the oropharynx were resected and reconstructed by the lateral upper arm flap.The size of the upper arm flap,the length of the vascular pedicle and the diameter of the vascular were recorded,and the perioperative complications,the recovery of swallowing,breathing and speech functions were evaluated.RESULTS The lateral upper arm flap of all the 10 cases were survived without necrosis.The flap sizes were(6×8)cm^(2)-(6×15)cm^(2),the pedicle lengths were 6-8 cm,the diameters of flap artery were 1-2.5 mm,and the diameters of the dominant reflux vein were 1.5-3.0 mm.Only 1 vein was anastomosed in all the patients,including 8 facial veins and 2 external jugular veins.The nasogastric feeding tubes were removed 14 to 45 days after operation for the patients who can eat orally.Six patients received postoperative radiotherapy with a dose of 60-66 Gy.And 4 patients did not need radiotherapy after surgery.Decannulation was performed 14-34 days after

关 键 词：口咽肿瘤 修复外科手术 上臂外侧皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]