改良胸大肌肌皮瓣在高风险头颈肿瘤患者术后缺损修复的应用  

Application of modified pectoralis major myocutaneous flap in postoperative defect repair in patients with high-risk head and neck tumors

作　　者：周杨 代学忠 李颖月 崔理明 鲍学钰 邓芳 张睿哲 ZHOU Yang;DAI Xuezhong;LI Yingyue;CUI Liming;BAO Xueyu;DENG Fang;ZHANG Ruizhe(Department of Otolaryngology and Head and Neck Surgery,The Third People's Hospital of Yunnan Province,Kunming,Yunnan Province,650011,China)

机构地区：[1]云南省第三人民医院耳鼻咽喉头颈外科,昆明650011

出　　处：《中国中西医结合耳鼻咽喉科杂志》2023年第5期378-382,共5页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的总结改良带蒂胸大肌肌皮瓣(PMMF)在高风险头颈肿瘤患者术后缺损组织修复中的体会和应用价值。方法选择我院2017年2月~2021年10月,17例头颈恶性肿瘤并均伴高风险(高龄、放疗后、糖尿病、心血管疾病、动脉硬化、周围血管病)患者,手术治疗导致头颈部、口腔颌面大范围缺损采用胸大肌肌皮瓣同期修复的效果观察。结果17例均顺利完成手术并度过围手术期,1例(糖尿病酮症,血糖波动较大、血糖控制不理想)咽瘘,经积极换药,对症治疗后愈合,2例皮瓣远端局部坏死,换药,缝合对症治疗后愈合,1例(外院术后+放疗30次复发)术后下颌部皮瓣远端裂开、瘘,未完全愈合。1例皮瓣稍过臃肿,重建舌体偏健侧,自觉言语不清,有不适感,3个月后复查臃肿较前减轻,言语稍有不清但基本能听懂,亦无明显不适感,吞咽正常。1例术后颈部瘢痕挛缩至仰头不适,予二次手术松解后恢复良好。余病例组织缺损、伤口愈合,患者头颈部功能及语音与吞咽功能均修复。结论改良胸大肌肌皮瓣(PMMF)血管恒定、制作简单,血供丰富、成活率高,供区位于头颈部放射野外,可为经放射治疗后头颈、口腔颌面区提供健康组织,组织量大,可做为高风险(高龄、放疗后、糖尿病、心血管疾病、动脉硬化、周围血管病)患者同期修复头颈、口腔颌面大面积组织缺损的手段。也可作为游离组织移植失败或局部复发挽救性扩大切除补救修复手段。Objective To summarize the experience and application value of modified pedicled pectoralis major myocutaneous flap(PMMF)in postoperative defect tissue repair in patients with high-risk head and neck tumors.Methods From February 2017 to October 2021 in our hospital,17 patients with head and neck malignant tumors with high risk(old age,post-radiotherapy,diabetes,cardiovascular disease,arteriosclerosis,peripheral vascular disease)were selected.The effect of simultaneous repair by pectoralis major musculocutaneous flap in the head,neck,oral and maxillofacial large-scale defects caused by operation was observed.Results All the 17 cases successfully completed the operation and passed the perioperative period.Pharyngeal fistula occurred in 1 case(diabetic ketosis,large blood sugar fluctuation,unsatisfactory blood sugar control),healed after active dressing change and symptomatic treatment.2 cases of local necrosis of distal flap were healed after dressing change and suturing.In 1 case(after surgery in another hospital+30 recurrences of radiotherapy),the distal end of the mandibular flap was split and fistula without complete healing.In another 1 case,the flap was slightly bloated,the reconstructed tongue was on the healthy side,and the speech was slurred and uncomfortable.After 3 months,the bloatedness was relieved.The speech was slightly unclear but basically understood,and there was no obvious discomfort,and swallowing function was normal.1 case suffered from neck scar contracture after operation to the point of discomfort when looking up,and recovered well after the second surgical release.In the remaining cases,tissue defects and wounds healed,and the patient's voice and swallowing functions were repaired.Conclusion The modified pectoralis major myocutaneous flap(PMMF)has constant blood vessels,simple fabrication,abundant blood supply and high survival rate.The donor site is located out the head and neck radiation field.It can provide healthy tissue for the oral and maxillofacial area after radiotherapy.It can be u

关 键 词：胸大肌肌皮瓣 高风险 口咽癌 缺损 修复 

分 类 号：R739.91[医药卫生—肿瘤]