带蒂或穿支皮瓣转移在外阴癌手术组织缺损Ⅰ期修补中的应用  

Application of pedicle or perforator flaps transfer in the stageⅠtissue defect repair after vulvar cancer surgery

作　　者：陈玉芬 白萍 赵玉乔 丛立楠 李楠 佐晶 张功逸 孙阳春 李淑敏 李强[3] Chen Yufen;Bai Ping;Zhao Yuqiao;Cong Linan;Li Nan;Zuo Jing;Zhang Gongyi;Sun Yangchun;Li Shumin;Li Qiang(Department of Gynecologic Oncology,Huanxing Cancer Hospital of Chaoyang District,Beijing 100122,China;Department of Gynecology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]北京市朝阳区桓兴肿瘤医院妇瘤科,北京100122 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院妇科,北京100021 [3]中国医学科学院整形外科医院综合整形科,北京100144

出　　处：《中华妇产科杂志》2025年第2期136-143,共8页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨带蒂或穿支皮瓣转移在外阴癌手术组织缺损Ⅰ期修补中的应用。方法收集2005年1月—2023年12月于北京市朝阳区桓兴肿瘤医院及中国医学科学院北京协和医学院肿瘤医院收治的20例行外阴广泛性切除或外阴扩大切除±腹股沟淋巴结切除+外阴缺损皮瓣转移术的外阴癌患者,分析其术后皮瓣成活状况、外阴的外观结构、性功能满意度及肿瘤复发、生存情况等。结果(1)20例患者的中位年龄为59岁(范围:29~73岁);复发患者14例,初治患者6例;病理类型:鳞癌14例,Paget病4例,恶性黑色素瘤1例,腺样囊性癌(涎腺型癌)1例。(2)20例患者中,6例行外阴广泛性切除术,14例行外阴扩大切除或外阴复发肿瘤扩大切除术(其中1例行腹股沟肿物扩大切除术),术中均同时行外阴缺损皮瓣转移术;11例同时行腹股沟淋巴结切除(或淋巴清扫)术,其中7例双侧腹股沟淋巴结切除(或淋巴清扫)术、4例单侧腹股沟淋巴结切除(或淋巴清扫)术。皮瓣来源:带蒂皮瓣12例,穿支皮瓣8例。20例患者均在术后10~14 d拆线,且转移皮瓣全部存活,皮瓣色泽红润、弹性好;17例转移皮瓣Ⅰ期愈合,2例因切口渗出延期至6周左右愈合,1例因切口感染予清创处理后6周愈合。术后半年复查,2例患者感觉阴阜肥厚、膨隆;其余18例均外阴丰满、有弹性,尿道口无移位,排尿时无尿线偏斜,阴道口无狭窄,无外阴瘢痕疼痛。除1例29岁未婚患者及6例65岁以上患者术前及术后均无性生活之外,其余13例患者术后均有正常性生活,性功能评估满意率达11/13。(3)皮瓣转移术后中位随访时间为56个月(范围:6~100个月),5年内复发9例(45%,9/20);死亡5例(25%,5/20),均死于外阴癌复发。20例患者的5年生存率为75%,其中6例初治患者为83%,14例复发再次手术治疗患者为71%。结论外阴癌手术同时行皮瓣转移外阴成形术,不影响患者术后的切口愈合。由于外阴的外观结�ObjectiveTo investigate the application of pedicled or perforator flaps transfer in the stageⅠtissue defect repair after vulvar cancer surgery.MethodsFrom January 2005 to December 2023,20 patients with vulvar cancer who underwent extensive episiectomy or extended episiectomy±inguinal lymph node resection+vulvar defect flap transfer were collected in Huanxing Cancer Hospital of Chaoyang District and Cancer Hospital and Peking Union Medical College,Chinese Academy of Medical Sciences.The survival status,appearance structure,sexual function satisfaction,tumor recurrence,and survival were analyzed.Results(1)The median age of the 20 patients was 59 years(ranged:29-73 years).There were 14 patients with recurrence and 6 patients with initial treatment.Pathological types:14 cases of squamous cell carcinoma,4 cases of Paget′s disease,1 case of malignant melanoma,1 case of adenoid cystic carcinoma(salivary gland type carcinoma).(2)Among the 20 patients,6 cases underwent extensive episiotomy and 14 underwent extended episiotomy(1 of them underwent extensive excision of inguinal masses).Simultaneous inguinal lymphadenectomy(or dissection)were performed in 11 cases,including 7 cases of bilateral inguinal lymph node resection(or dissection)and 4 cases of unilateral inguinal lymph node resection(or dissection).Flap source:pedicled flap in 12 cases,perforator flap in 8 cases.All the 20 patients were removed at 10-14 days after operation,and all of them survived with rosy skin color and good elasticity.Seventeen cases of transferred flaps healed at stageⅠ,2 cases healed at about 6 weeks due to incision leakage,and 1 case healed at 6 weeks after incision infection debridement.Six months after the operation,2 cases felt that the pubic mound was thick and swollen.The other 18 cases showed vulva fullness and elasticity,no displacement of urethral opening,no deviation of urethra during urination,no stenosis of vaginal opening,no vulvar scar pain.In addition to 1 unmarried 29-year-old patient and 6 patients over 65 years old who

关 键 词：外阴肿瘤 外科皮瓣 外阴切除术 修复外科手术 切口愈合 

分 类 号：R737.35[医药卫生—肿瘤]