经下颌骨裂开外旋入路切除扁桃体癌术后组织缺损的修复

发布时间：2018-03-30 00:24

本文选题：扁桃体癌　切入点：皮瓣　出处：《临床耳鼻咽喉头颈外科杂志》2017年06期

【摘要】：目的:探讨经下颌骨裂开外旋切除扁桃体癌术后组织的缺损修复方法。方法:把24例扁桃体癌术后缺损分成3类:①小缺损8例,分别为扁桃体窝或(和)咽弓等咽侧缺损,其中4例采用中厚皮片修复,另外4例则采用前臂桡侧皮瓣进行修复;②中缺损5例,除咽侧缺损外,同时伴软腭或舌根小缺损,采用前臂桡侧皮瓣修复2例,股前外侧瓣修复3例;③大缺损11例,除咽侧缺损外,同时伴软腭和舌根大缺损,采用股前外侧瓣修复2例,胸大肌皮瓣修复9例。结果:24例扁桃体癌修复术后创面均一期愈合。4例皮片全部成活,6例前臂桡侧皮瓣修复术后缺损中,有1例前臂皮瓣于修复术后5d出现血管危象失败,后经口腔和颌下取出坏死皮瓣,创面自行愈合。另5例前臂桡侧皮瓣和5例股前外侧瓣全部存活。9例胸大肌皮瓣修复术后组织缺损,手术创面全部一期愈合,修复部位虽出现臃肿,但半年后明显减轻。有软腭侵犯的患者修复术后,1例出现轻微流质鼻腔返流,3例患者术后讲话含糊,但能听懂,其他患者的咀嚼、吞咽、呼吸、语言功能恢复良好。结论:T2扁桃体癌切除术后咽侧小缺损可用中厚皮片或前臂皮瓣修复;T2、T3扁桃体癌的咽侧加软腭或舌根小缺损,可用前臂或股前外侧瓣修复;T3及以上扁桃体癌的咽侧加软腭及舌根大缺损,可采用股前外侧瓣或胸大肌皮瓣修复。
[Abstract]:Objective: to investigate the method of repairing the defects of tonsillar carcinoma after external rotation resection of tonsil carcinoma through mandibular fissure. Methods: 24 cases of tonsillar carcinoma were divided into 3 types and 8 cases, including tonsil fossa or / and pharynx arch. Among them, 4 cases were repaired with moderate thickness skin graft, the other 4 cases were repaired with radial forearm flap in 5 cases. In addition to pharynx side defect, accompanied by soft palate or tongue root defect, 2 cases were repaired with forearm radial flap. The anterolateral femoral flap was used to repair 3 large defects in 3 cases and 3 large defects in 3 cases. In addition to the pharyngeal defect, there were two cases with soft palate and tongue root defect, and 2 cases were repaired with anterolateral femoral flap. Results the wound surface of 24 cases with tonsillar carcinoma was healed in the first stage. All the 4 cases survived and 6 cases were repaired with radial forearm flap. One case of forearm flap had vascular crisis failure 5 days after repair. The necrotic flap was removed from oral cavity and submaxillary flap, and the wound healed by itself. The other 5 cases of radial forearm flap and 5 cases of anterolateral femoral flap were all survived to repair the tissue defect after operation, and all the surgical wounds were healed in one stage, and the tissue defect was repaired by pectoralis major myocutaneous flap. Although the repair site was bloated, it was significantly alleviated half a year later. One patient with soft palate invasion showed slight fluid nasal regurgitation after repair. 3 patients spoke vaguely, but they could understand the other patients' chewing, swallowing and breathing. Conclusion the small pharyngeal defect can be repaired with moderate thickness skin graft or forearm flap after resection of T2T 2 tonsillectomized tonsil carcinoma with soft palate or tongue root defect in T 2 T 3 tonsil carcinoma. The anterior lateral femoral flap or anterolateral femoral flap can be used to repair the large defects of pharynx plus soft palate and tongue root in tonsil carcinoma of T 3 and above, and the anterolateral femoral flap or pectoralis major flap can be used to repair the defects.
【作者单位】：复旦大学附属眼耳鼻喉科医院耳鼻咽喉科;
【分类号】：R739.64

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