管状上臂上外侧游离皮瓣重建近全喉切除术后发音功能  

Reconstruction of phonatory function using a tubular free flap from upper-lateral upper arm after near-total laryngectomy

作　　者：杨柳[1] 郑义涛 李文[1] YANG Liu;ZHENG Yitao;LI Wen(Department of Otolaryngology Head and Neck Surgery,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,成都610041

出　　处：《中国修复重建外科杂志》2025年第2期209-214,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川大学华西医院学科卓越发展1·3·5工程临床研究基金(2024HXFH004);华西医院临床新技术项目(医临新2022-303号、医临新2024-037号)。

摘　　要：目的探讨管状上臂上外侧游离皮瓣在近全喉切除术后修复喉-气管环周缺损重建发音功能的可行性。方法回顾分析2021年6月—2023年10月收治的7例因喉癌行近全喉切除患者临床资料。其中男6例,女1例;年龄48~70岁,中位年龄59岁。病程1~11个月,中位病程6个月。术前病理活检诊断为鳞状细胞癌,肿瘤分型:声门型5例,声门上型1例,贯声门型1例;TNM分期:T4N0M06例,T4N2M01例;2017美国癌症联合委员会(AJCC)分期均为Ⅳ期。术前上臂MRI血管增强扫描观察上臂上外侧区的血供情况。在近全喉切除双侧颈部淋巴结清扫术后,测量喉-气管缺损区面积,于上臂上外侧切取游离皮瓣,大小7.0 cm×5.0 cm~8.0 cm×7.0 cm,皮瓣卷成管状,下接颈根部颈段气管残端,上接舌根处会厌残端。4例患者补充放、化疗,1例补充放、化疗及靶向治疗,2例患者未做补充治疗。结果7例患者均获随访,随访时间1~2年,平均1年3个月。4例切口Ⅰ期愈合;2例患者轻微咽瘘,经换药后愈合,皮瓣成活;1例皮瓣坏死咽瘘,经换药后愈合。所有患者术后1个月内均经口进食,均保留气管套管。6例皮瓣成活患者术后15 d~2个月均逐渐适应了新的发音模式,获得满意发音功能。4例患者术后有轻微误咽。随访期间未见局部复发或远处转移。患者上臂运动功能不受影响,仅在切口附近区域出现部分感觉缺失,切口瘢痕能为短袖所掩盖。结论选择合适的病例,采用管状上臂上外侧游离皮瓣修复喉癌近全喉切除术后喉-气管环周缺损,可获满意发音功能。供区运动功能得到保存,切口隐蔽美观。Objective To explore the feasibility of reconstruction of phonatory function by using a tubular free flap from upper-lateral upper arm to repair the laryngotracheal circumferential defect after near-total laryngectomy for laryngeal cancer.Methods A retrospective study was conducted on 7 patients who underwent near-total laryngectomy between June 2021 and October 2023,aged from 48 to 70 years(median,59 years),6 males and 1 female.The disease duration ranged from 1 to 11 months,with a median of 6 months.Pathological diagnosis of preoperative biopsy was squamous cell carcinoma.Tumor classification:glottic type in 5 cases,supraglottic type in 1 case,transglottic type in 1 case;TNM staging:T4N0M0 in 6 cases,T4N2M0 in 1 case;American Joint Committee on Cancer(AJCC)staging in 2017 was stageⅣ.Preoperative MRI angiography of upper arm was performed to investigate the blood supply in the upper and lateral regions of the upper arm.After near-total laryngectomy and bilateral neck lymph node dissection,the area of the laryngotracheal defect was measured.A free flap measuring 7.0 cm×5.0 cm to 8.0 cm×7.0 cm was harvested from the upper-lateral upper arm,rolled into a tube shape,and connected between the stump of the cervical trachea in the neck root and that of the epiglottis at the tongue base.Four patients received adjuvant radiochemotherapy,1 patient received radiochemotherapy and targeted therapy,2 patients adopted no further adjuvant treatment.Results All 7 patients were followed-up 1-2 years(mean,1 year and 3 months).Four patients had primary wound healing,2 patients had minor pharyngeal fistulas that healed after dressing change,1 patient experienced pharyngeal fistula because of flap necrosis and the wound still healed without secondary surgery.All patients took food orally within 1 month after operation,and the tracheal cannula was retained.Six patients with survived flap gradually adapted to their new pronunciation mode and obtained satisfactory phonatory function from 15 days to 2 months after operation.Four pati

关 键 词：喉癌 近全喉切除术 游离皮瓣 上臂皮瓣 发音重建 

分 类 号：R73[医药卫生—肿瘤]