晚期喉癌下咽癌术后缺损的修复

发布时间：2018-03-08 19:42

本文选题：喉癌　切入点：下咽癌　出处：《中国耳鼻咽喉颅底外科杂志》2016年02期 　论文类型：期刊论文

【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复杂的多重组织和器官的缺损需要用多种自身材料叠加修复以重建上消化道;3密切观察游离组织瓣的血运状况,及早处理坏死的组织瓣并重新修复,以确保伤口尽快愈合。
[Abstract]:Objective to summarize and analyze the repair experience of tongue, throat, cervical esophagus and neck skin defects in patients with advanced laryngeal carcinoma after hypopharyngeal carcinoma. Methods from January 2005 to December 2012, 177 patients with hypopharyngeal carcinoma, 147 males, were operated on. Among them, 49 cases of stage IV stage IV hypopharyngeal carcinoma, 55 cases of recurrent laryngeal carcinoma and 29 cases of recurrent hypopharyngeal carcinoma were treated for the first time. Total hypopharyngectomy was performed in 29 cases, total hypopharyngeal neck esophagectomy in 33 cases, total hypopharyngeal neck esophagectomy in 26 cases, total hypopharyngoglossal radical resection in 29 cases, total hypopharyngeal neck esophagectomy in 33 cases. Total hypopharynx and total larynx cervical esophagectomy was performed in 1 case. Type of defect and repair materials: 120 patients with hypopharyngeal proximal circumferential defect were treated with a single flap, including 25 submental flap and 53 pectoralis major myocutaneous flap. There were 42 cases of anterolateral femoral flap, 57 cases of hypopharyngeal circumferential defect, 15 cases of hypopharyngeal circumferential defect, including 9 cases of anterolateral femoral flap and 6 cases of pectoralis major myocutaneous flap, and 5 cases of free jejunum flap to repair peri-hypopharyngeal ring defect with oropharynx. There were 21 cases with cervical esophageal defect, 10 cases with combined use of free jejunum flap, pectoralis major myocutaneous flap or / and anterolateral femoral flap to repair hypopharyngeal circumferential defect with tongue, oropharynx, neck esophageal defect or (and) cervical skin tissue defect. There were 11 cases of hypopharynx with total esophageal defect repaired by gastric retraction tube, 95 cases of postoperative radiotherapy, and no radiation necrosis of tissue flap. Results the success rate of one operation was 92.1 / 163 / 1770.14 cases of repair flap necrosis were successfully repaired, including 4 cases of jejunum. There were 6 cases of pectoralis major musculocutaneous flap on the other side, 4 cases of free anterolateral femoral flap on the other side, 6 cases of pharyngeal fistula healed after dressing change, 13 cases of recurrence of pharynx and fistula (7 cases of re-operation). There were 6 cases of radiotherapy and chemotherapy, 5 cases of esophageal cancer, 17 cases of cervical lymph node recurrence (9 cases of reoperation, 8 cases of radiotherapy and chemotherapy), 6 cases of lung metastasis, 2 cases of liver metastasis and 4 cases of multiple distant metastasis. There were 7 cases of local recurrence and distant metastasis. 23 cases died of local recurrence and 12 cases of distant metastasis. The 3-year survival rate of the whole group was 50.4 and the 5-year survival rate was 39.4%. Conclusion\\\. According to the extent of the defect and the condition of the patient, the defect of complex multiple tissues and organs should be repaired with multiple self-repair materials, and the blood flow of the free tissue flap should be closely observed by the reconstruction of the upper digestive tract. Early treatment and repair of necrotic tissue flap to ensure wound healing as soon as possible.
【作者单位】：湖南省肿瘤医院中南大学湘雅医学院附属肿瘤医院头颈外科;
【分类号】：R739.63

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