双蒂供血的胸大肌肌皮瓣在喉癌和下咽癌手术缺损修复中的应用

发布时间：2018-11-16 11:56

【摘要】：目的:探讨双蒂供血的胸大肌肌皮瓣在喉癌、下咽癌手术缺损修复中的应用。方法:应用胸大肌肌皮瓣一期重建喉癌和下咽癌术后缺损22例,均为初治患者。术中保留胸肩峰血管的胸肌支及胸外侧血管的分支,制备成起始部不含肌肉的双蒂血管筋膜束,肌皮瓣经锁骨下隧道至缺损区。术后密切观察颈部术区的皮下肿胀情况、引流物的量和颜色等,以排除术区血肿的发生,有怀疑时要及时探查。结果:22例患者胸大肌肌皮瓣全部成活,发生咽瘘2例,经换药后愈合;术后接受放疗21例,无继发肌皮瓣坏死。随访6~24个月,1例颈段食管环周缺损卷筒修复者,放疗后8个月出现吻合口狭窄,后行胃造瘘治疗;余21例吞咽功能恢复良好。13例保留喉功能患者,仅1例带管生存,拔管率92.3%,均无交流障碍。因随诊时间短,无死亡患者。结论:双蒂供血的胸大肌皮瓣,若血运得到充分保证,术后不需要复杂繁琐的设备来观察和监测皮瓣血运,仅排除可能导致肌皮瓣坏死的因素,即能保证胸大肌皮瓣的成活。
[Abstract]:Objective: to investigate the application of double pedicle pectoralis major myocutaneous flap in the repair of laryngeal carcinoma and hypopharyngeal carcinoma. Methods: 22 cases of laryngeal carcinoma and hypopharyngeal carcinoma were reconstructed with pectoralis major myocutaneous flap. The branches of the pectoralis muscle and the lateral thoracic vessels were preserved during the operation, and the musculocutaneous flap was made into a double-pedicled vascular fascia bundle without muscle, and the myocutaneous flap passed through the subclavian tunnel to the defect area. The subcutaneous swelling, the quantity and color of drainage were observed closely after operation to exclude the occurrence of hematoma in the operation area, and timely exploration should be made in case of doubt. Results: all the 22 cases of pectoralis major myocutaneous flap survived, pharyngeal fistula occurred in 2 cases, healed after dressing change, 21 cases received radiotherapy after operation, no secondary myocutaneous flap necrosis. Follow-up for 6 to 24 months, 1 case of cervical esophageal circumferential defect reconstructive, 8 months after radiotherapy, anastomotic stenosis, and then gastrostomy treatment; Of the remaining 21 patients with good recovery of swallowing function, only one patient survived with a tube in 13 patients with laryngeal function, and the extubation rate was 92.33.There was no communication disorder. Because of the short follow-up time, no patients died. Conclusion: if the blood supply of the pectoralis major myocutaneous flap with two pedicles is fully guaranteed, the survival of the pectoralis major myocutaneous flap can be ensured by removing the factors that may lead to the necrosis of the pectoralis major myocutaneous flap.
【作者单位】：临沂市肿瘤医院头颈外科;
【分类号】：R739.6

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