摘要
目的总结分析晚期喉癌下咽癌术后的舌部、咽喉部、颈段食管及颈部皮肤等组织缺损的修复经验。方法 2005年1月~2012年12月共手术治疗喉癌、下咽癌患者177例,男147例,女30例。年龄42~75岁,中位年龄51岁。其中首次治疗的IV期喉癌49例、IV期下咽癌44例、复发喉癌55例和复发下咽癌29例。原发灶切除：全喉＋全下咽切除88例,全喉＋全下咽＋舌根切除29例,全喉＋全下咽＋颈段食管切除33例,全喉＋全下咽＋颈段食管切除＋颈部皮肤切除26例,全舌＋全下咽＋全喉＋颈段食管切除＋颈部皮肤切除1例。缺损类型及修复材料：下咽近环周缺损120例患者行单一皮瓣修复,其中颏下皮瓣25例、胸大肌肌皮瓣53例、股前外侧皮瓣42例。下咽环周缺损57例患者行单一皮瓣修复下咽环周缺损15例,包括股前外侧皮瓣9例和胸大肌肌皮瓣6例;行游离空肠瓣修复下咽环周缺损合并口咽、颈段食道缺损者21例;联合应用游离空肠瓣、胸大肌肌皮瓣或（和）股前外侧皮瓣修复下咽环周缺损合并舌、口咽、颈段食道缺损或（和）颈部皮肤组织缺损者10例;采用胃上徙管胃成形修复下咽合并全食道缺损11例。术后放疗95例,组织瓣无放射性坏死。结果一次手术成功率92.1%（163/177）;修复瓣坏死14例患者行再次修复手术成功,包括空肠4例,另一侧胸大肌皮瓣6例,另一侧游离股前外侧皮瓣4例。咽瘘经换药后愈合6例。无手术死亡病例。咽部及造瘘口复发13例（再手术7例,放化疗6例）,食管二重癌5例予以放化疗,颈部淋巴结复发17例（再手术9例,放化疗8例）。肺转移6例,肝转移2例,多个远处转移4例,局部复发并远处转移7例。局部复发死亡23例,远处转移死亡12例。全组3年生存率50.4%;5年生存率39.4%。结论 1晚期和复发的喉癌及下咽癌术后软组织缺损,需根据患者的缺损范围和身体状况选择自体修复材料;2复杂的�
Objective To summarize experience for repairing defects of tongue,pharynx,esophagus and cervical skin after resection of laryngeal and hypopharyngeal carcinoma. Methods From Jan 2005 to Dec 2012,177 patients suffering from laryngeal and hypopharyngeal carcinoma received surgical treatment in our department. Of them,147 were male and 30 were female. Their age ranged from 42 to 75 years old with a median age of 51. Among the first time treatment cases,49 were laryngeal carcinoma of stage IV and 44 were hypopharyngeal carcinoma of stage IV. Among the recurrence cases,55 were laryngeal carcinoma and 29 were hypopharyngeal carcinoma. As for the resection of primary locus,total resection of larynx and hypopharynx was performed in 88 cases,total resection of larynx,hypopharynx and base tongue was performed in 29 cases,total resection of larynx,hypopharynx and cervical esophagus was performed in 22 cases,total resection of larynx,hypopharynx and pulled-out the whole esophagus was performed in 11 cases,total resection of larynx,hypopharynx,cervical esophagus and skin was performed in 26 cases,total resection of tongue,larynx,hypopharynx and cervical esophagus and skin was performed in one. As for the postoperative defect and repair method, the nearcircumferential hypopharyngeal defects of 120 cases underwent reconstruction with single flap including submental flap in 25 cases,pectoralis major myocutaneous flap in 53,femoral anterolateral flap in 42. The circumferential hypopharyngeal and esophageal defects of 57 cases received reconstruction with single and / or composite flap（ s） ： femoral anterolateral flap in 9cases,pectoralis major myocutaneous flap plus thoracoacromal artery perforate flap in 6 and free jejunum flap in 21;multiple tissue flaps were utilized for reconstruction the defects of oralpharyngeal,circumferential hypopharyngeal,cervical esophageal and skin defects in 10 cases,including jejunum flap,pectoralis major myocutaneous flap or / and femoral anterolateral flap; 11 cases underwent gastric-migrati
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2016年第2期120-124,128,共6页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
喉癌
下咽癌
缺损
皮瓣
修复
Laryngeal and hypopharyngeal neoplasm
Defect
Flap
Reconstruction
