喉全切除后气管造瘘口复发癌缺损外科修复比较

目的探索喉全切除后气管造瘘口复发癌缺损外科修复的治疗效果。方法对18例喉全切除后气管造瘘口复发癌实施外科治疗。其中Ⅰ型7例,颈部单纯切口,胸大肌肌皮瓣修复颈部皮肤气管造瘘口缺损;Ⅱ型6例,颈肢或胸联合切口,前臂皮瓣或胸大肌肌皮瓣(游离前臂皮瓣5例,胸大肌肌皮瓣1例)修复部分喉咽切除;Ⅲ型3例,颈腹联合切口,游离空肠修复全喉咽、颈段食管;Ⅳ型2例,颈胸腹联合切口,胃上拉修复全喉咽、全食管。Ⅱ、Ⅲ、Ⅳ型的颈部皮肤气管造瘘口缺损均用胸大肌肌皮瓣修复。结果颈部缺损胸大肌肌皮瓣均成活;咽瘘4例(其中游离空肠1例,前臂皮瓣2例,胃上拉咽瘘出血1例);全部病例术后均能进食;随访6～74个月,3例出现不同程度吞咽梗阻。结论喉全切除后气管造瘘口复发癌外科治疗缺损,修复选择应根据原发肿瘤治疗的经过及气管造瘘口复发癌侵及范围来确定修复方法。     

前臂桡侧游离皮瓣咽食管重建

下咽部晚期肿瘤传统采用手术切除联合放疗 ,下咽部手术缺损早些时候多采用颈部临近组织进行修复 ,如胸大肌肌皮瓣、斜方肌肌皮瓣、背阔肌肌皮瓣等。195 9年 Seidenberg介绍了游离空肠移植咽食管重建 ,1985年 Harii介绍了一种游离管状皮瓣咽食管重建方法 ,此后 ,游离前臂桡侧皮筋膜瓣 (RFFF)逐渐被用于进行下咽和颈段食管缺损修复重建。RFFF供皮区定位在前臂桡侧非优势桡动脉和头静脉供血区 ,皮瓣连接食管端的宽度为 6～ 8cm,与口咽部连接的宽度为 12～ 14 cm,皮瓣末端呈 2 cm长的三角形突出和颈段食管纵切口嵌合。以从口咽部残端到食管…     

口咽癌的外科治疗

目的：探讨口咽癌扩大切除一期再建的手术方法,观察并发症及术后语言、吞咽功能恢复情况。方法：30例口咽癌中软腭癌2例,扁桃体癌3例,咽侧壁癌16例,舌根癌9例;Ⅲ、Ⅳ期患者占63．3％（19／30）,颈淋巴结转移53．3％（16／30）。22例用下颌骨切开外旋或切除升支入路进行了肿块根治性切除,同期行颌下清扫术1例,肩胛舌骨肌上清扫术3例,根治性颈清扫术26例。咽部缺损用带蒂胸大肌皮瓣整复17例,胸锁乳突肌皮瓣4例,额顶部岛状皮瓣3例,斜方肌皮瓣和颈阔肌皮瓣各1例,游离前臂皮瓣＋带蒂复合瓣4例。手术＋放疗25例,单纯手术5例。结果：3年生存率为66．7％（14／21）。术后局部感染7例,涎瘘5例,皮瓣远端部分坏死4例,语言、吞咽功能基本恢复。结论：局部缺损范围和选择适宜的肌皮瓣是恢复腭咽闭合及舌可动性的主要因素,带蒂胸大肌皮瓣修复软腭、口咽侧壁及舌根大面积缺损效果良好。     

晚期扁桃体癌放疗后复发的手术治疗

目的　探讨晚期扁桃体癌放疗后复发的手术治疗方法。方法　对我科 1 993年 6月～ 2 0 0 0年 8月诊治的 2 3例晚期扁桃体癌根治性放疗后复发的病例 ,采取颈 下颌骨正中切开外旋入路切除扁桃体复发肿瘤 ,带蒂的胸大肌皮瓣I期修复缺损 ,并行颈淋巴结清扫术。结果　全部病例随访 3～ 1 0年 ,3年生存率 2 6 .1 %(6 / 2 3) ,3年无瘤生存率 1 7.4 %(4/ 2 3) ,3年内局部再复发 1 9例 ,其中死亡 1 6例 ,失访 1例。皮瓣下、颈部局部感染 5例 ,皮瓣远端部分坏死 2例 ,呼吸困难 1例 ,误咽 2例。结论　晚期扁桃体癌放疗后复发的预后差。对适合病例作下颌骨正中切开外旋入路切除肿瘤 ,带蒂胸大肌皮瓣I期修复缺损 ,并行颈淋巴结清扫术 ,可延长病人生命 ,减少痛苦 ,提高生存质量。     

晚期扁桃体鳞状细胞癌的综合治疗及胸大肌肌皮瓣一期修复缺损

目的　探讨晚期扁桃体癌有效的治疗方法。方法　 1991年以来福建医科大学附属第一医院耳鼻咽喉科采用口腔下颌骨升支联合径路切除扁桃体癌 ,胸大肌肌皮瓣一期修复缺损 ,并加功能性颈淋巴结清扫术 ,配合术前化学治疗和术后放射治疗 ,治疗晚期扁桃体鳞状细胞癌 8例。结果　全部病例随访 3～ 9年 ,6例存活 3年以上 ,存活率 6 / 8;2例死亡 ,1例于术后 3个月死于放射性下颌骨骨髓炎大出血 ,1例术后 2年死于食管癌。并发症 :放射性下颌骨骨髓炎 2例 ,术后短暂食物返流入鼻腔 2例。结论　口腔下颌骨升支联合径路 ,可于直视下在肿瘤外 1 0cm的边界范围内安全地将肿瘤完整大块切除。配合功能性颈淋巴结清扫术、术前化学治疗和术后放射治疗 ,对减少肿瘤复发、提高疗效具有重要意义。胸大肌肌皮瓣具有取材方便 ,肌皮瓣成活率高 ,适合咽部缺损修复     

晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择

目的:探讨以不同组织移植物Ⅰ期重建晚期下咽癌、喉复发癌术后颈部、下咽食管缺损的适应证及治疗效果。方法:喉复发癌36例, 肿瘤切除后采用胸大肌肌皮 瓣修补组织缺损18例,肩胸皮瓣修补4例,胃代食管修补2例,胸部推移皮瓣重建下颈部与上纵隔组织缺损,并消灭手术死腔12例。晚期下咽癌16例,颈段食管癌8例,以游离空肠整复1例, 健侧喉黏膜瓣修复咽部缺损8例,喉气管代食道8例,胸大肌皮瓣修复咽部缺损2例,胃代食管2例,游离前臂皮瓣修复下咽1例。 结果:术中无一例死亡,术后无修复组织坏死 ,全部组织瓣存活。采用健侧喉黏膜瓣修复者,仅 1例有术前放疗史的患者发生术后咽漏,胸大肌皮瓣 修复者发生咽漏1例,胃代食道术后发生咽漏1例。全部病例愈合后均恢复正常饮食。随访 9～84个月,14例出现吞咽梗阻,可进流质饮食。结论:下咽癌患者术后组织缺损的修复方法各有侧重。肿瘤的部位和手术后组织缺损的大小是选择修复方法的首要因素;其次,应结合患者的年龄和全身状况,考虑减少并发症。     

下咽癌喉癌术后广泛下咽及颈段食管缺损修复方法的比较

目的：探讨4种方法Ⅰ期修复下咽癌及晚期喉癌术后广泛下咽及颈段食管缺损的适应证及治疗效果。方法：用健侧喉黏膜瓣修复部分咽部缺损12例(伴颈段食管切除术2例)．胸大肌皮瓣修复部分咽部缺损6例，游离前臂皮瓣修复保留喉的部分下咽切除术2例．游离空肠重建全下咽和食管上段缺损1例。结果：术中无一例死亡，术后无修复组织坏死．全部组织瓣存活。采用健侧喉黏膜瓣修复者，仅1例术前放疗的患者术后发生咽漏；胸大肌皮瓣修复者，1例发生咽漏。全部病例愈合后均可进普通饮食。随访9～84个月，4例出现吞咽梗阻。结论：下咽癌缺损的修复方法各有侧重。肿瘤的部位和大小是选择修复方法最重要的因素；其次，也应仔细考虑减少并发症。     

晚期扁桃体鳞状细胞癌的综合治疗及胸大肌肌皮瓣一期修复缺损

目的 探讨晚期扁桃体癌有效的治疗方法。方法 19991年以来福建医科大学附属第一医院耳鼻咽喉科采用口腔下颌骨升支联合径路切除扁桃体癌，胸大肌肌皮瓣一期修复缺损。并加功能性颈淋巴结清扫术，配合术前化学治疗和术后放射治疗，治疗晚期扁桃桃鳞状细胞癌8例。结果全部病例随访3－9年，6例存活3年以上，存活率6／8；2例死亡，1例于术后3个月死于放射性下颌骨骨髓炎大出血，1例术后2年死于食管癌。并发症：放射性下颌骨骨髓炎2例，术后短暂食物返流入鼻腔2例。结论 口腔下颌骨升支联合径路，可于直视下在肿瘤外1．0cm的边界范围内安全地将肿瘤完整大块切除。配合功能性淋巴结清扫术、术前化学治疗和术后放射治疗，对减少肿瘤复发、提高疗效具有重要意义。胸大肌肌皮瓣具有取材方便，肌皮瓣成活率高，适合咽部缺损修复。     

口咽癌的外科治疗

目的：探讨口咽癌扩大切除一期再建的手术方法，观察并发症及术后语言，吞咽功能恢复情况。方法：３０例口咽癌中软腭癌２例，扁桃体癌３例，咽侧壁癌１６例，舌根癌９例；Ⅲ，Ⅳ期患者６３．３％（１９／３０），颈淋巴结转移５３．３％（１６／３０），２２例用下颌骨切开外旋或切除切支入路进行了肿块根治性切除，同期行颌下清扫术１例，肩胛舌骨肌上清扫术３例，根治性颈清扫术２６例。咽部缺损用带蒂胸大肌皮瓣整复１７例，胸倘     

上颌窦癌游离皮瓣修复术后缺损的疗效观察

目的探讨上颌窦癌不同T分期术后游离皮瓣修复术后缺损的疗效。方法上颌窦癌术后游离皮瓣修复共30例，采用前臂桡侧游离皮瓣一期修复术后缺损18例，股前外侧皮瓣一期修复术后缺损12例。结果18例前臂皮瓣修复者中，17例成活，成活率94．4％；12例股前外侧皮瓣修复者中，11例成活，成活率91．7％。结论前臂桡侧游离皮瓣、股前外侧皮瓣一期修复上颌窦癌术后缺损是一种切实可行的有效方法。     

Contralateral Hemilaryngotracheal Flap Reconstruction of the Hypopharynx in Pyriform Carcinoma Resection

Objectives: To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique—laryngotracheal fissure approach and laryngotracheal flap reconstruction—is presented. Study Design: Prospective. Methods: From August 1991 to December 1995, 44 consecutive patients with advanced hypopharyngeal cancer, mostly involving pyriform sinus, were operated on with this technique. The functional and oncologic results and complications were evaluated. Results: Reconstruction was completed by using the laryngotracheal flap in 75% of patients, while the other 25% required ddditional patch-on pectoralis major myocutaneous flaps. Pharyngoesophageal stenosis occurred in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastases developed in the follow-up period and six over the contralateral neck not treated surgically. The 5-year Kaplan-Meier disease-free survival was 46.8%. Conclusions: The authors' experience indicates that this is a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results, and low complication.     

Supraclavicular flap in head and neck reconstruction: experience in 50 consecutive patients

The supraclavicular flap (SCF) is a fasciocutaneous flap used to cover head, oral, and neck region defects after tumor resection. Its main vascular supply is the supraclavicular artery and accompanying veins and it can be harvested as a vascularised pedicled flap. The SCF serves as an excellent outer skin cover as well as a good inner mucosal lining after oral cavity and head-neck tumor resections. The flap has a wide arc of rotation and matches the skin colour and texture of the face and neck. Between March 2006 and March 2011, the pedicled supraclavicular flap was used for reconstruction in 50 consecutive patients after head and neck tumor resections and certain benign conditions in a tertiary university hospital setting. The flaps were tunnelized under the neck skin to cover the external cervicofacial defects or passed medial to the mandible to give an inner epithelial lining after the oral cavity and oropharyngeal tumor excision. Forty-four of the 50 patients had 100% flap survival with excellent wound healing. All the flaps were harvested in less than 1 h. There were four cases of distal tip desquamation and two patients had complete flap necrosis. Distal flap desquamation was observed in SCFs used for resurfacing the external skin defects after oral cavity tumor ablation and needed only conservative treatment measures. Total flap failure was encountered in two patients who had failed in previous chemoradiotherapy for squamous cell cancer of the floor of mouth and tonsil, respectively, and the SCF was used in mucosal defect closure after tumor ablation. The benefits of a pedicled fasciocutaneous supraclavicular flap are clear; it is thin, reliable, easy, and quick to harvest. In head, face and neck reconstructions, it is a good alternative to free fasciocutaneous flaps, regional pedicled myocutaneous flaps, and the deltopectoral flap.     

Recurrent advanced (T3 or T4) head and neck squamous cell carcinoma: is salvage possible?

BACKGROUND: Salvage surgery is often the only curative option for recurrent cancer. In patients whose initial tumor is stage T3 or T4, the primary therapy often makes salvage even more difficult. We therefore analyzed the outcome in patients who were originally treated for T3 or T4 squamous cell carcinoma of the oral cavity, larynx, oropharynx, or hypopharynx and who then had a recurrence and chose to undergo further therapy for cure. PATIENTS AND METHODS: From 1980 to 2000, a total of 940 patients were treated for stage T3 or T4 cancer. Forty-eight patients underwent salvage therapy for recurrence: 24 for primary site recurrence, 20 for regional recurrence, and 4 for locoregional recurrence. RESULTS: The mean time to recurrence was 14.0 months, and the mean survival time was 26.2 months. Among the 28 patients treated for primary site recurrence, the mean time to rerecurrence was 12.6 months, and the mean survival time was 27.3 months. Only 5 of the 28 patients had prolonged survival. The stage of the recurrent disease did not influence outcome. Among the 20 patients treated for neck recurrence, the mean time to recurrence was 14.0 months, and the mean survival time was 25.0 months. Six of the 20 patients had prolonged survival, but none had a recurrence in a previously dissected and irradiated neck. CONCLUSIONS: These results show the limited potential for survival in patients who have a recurrence after treatment for advanced primary site head and neck cancer. Patients who have not undergone all modalities of therapy have the potential for salvage, but even then the chances are limited. Given the morbidity of salvage therapy, and the limited chance for cure, physicians must cautiously counsel patients who are contemplating treatment of recurrent cancer after therapy for advanced disease.     

Is routine follow-up useful after combined-modality therapy for advanced head and neck cancer?

OBJECTIVE: To evaluate the usefulness of routine follow-up in a selected group of patients with head and neck cancer. DESIGN: Retrospective cohort study with follow-up of 5 years for all patients. PATIENTS: Three hundred two patients with advanced (stage II or IV) squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx were treated with curative intent with surgery and postoperative radiation therapy between January 1, 1970, and December 31, 1990. MAIN OUTCOME MEASURE: Survival after recurrence of the index tumor or the development of a second head and neck primary tumor. RESULTS: Overall actuarial 5-year survival was 56%. Relapse occurred in 119 patients, and salvage therapy was attempted in 49 patients. Only 2 patients survived to 5 years after relapse. CONCLUSION: In patients with advanced head and neck squamous cell carcinoma, routine follow-up is more important for evaluation of treatment results and emotional support than of benefit in improving patient survival.     

The Platysma Myocutaneous Flap: Underused Alternative for Head and Neck Reconstruction

Objectives The use, advantages, and disadvantages of the platysma flap were assessed. Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001. Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the χ² test. Results Thirty‐four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions. Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects.     

Clinical review of mucoepidermoid carcinomas

Mucoepidermoid carcinoma is a rare head and neck cancer tumor, composed of both mucous and epidermoid cells. We retrospectively reviewed the case of 36 such patients hospitalized in the last 24 years (between 1978 and 2002) at Kurume University Hospital, focusing on origin, treatment, and treatment outcome. In this study, 33 patients undergoing currative treatment were studied in detail. Tumors originated in major salivary glands in 24 and in the oral cavity, paranasal cavity, and oropharynx in 3 each. Salivary gland carcinomas were graded, clinically and histopathologically based on the criteria of Goode et al. as follows: low (n = 3), intermediate (n = 3), and high (n = 18). All patients underwent radical surgery. Lymphnode metastasis was detected in 9, distant metastasis in 6 (lung: 4; liver: 1; bone: 1), and local recurrence in 5 patients. Lymphnode recurrence was detected in 3. Survival was calculated with Kaplan-Meier's methods. Five-year overall survival was 64%, i.e., 56% in salivary gland malignancy, 67% in oral cavity malignancy, 100% in paranasal cavity malignancy and 100% in oropharynx malignancy. Five-year survival was 76% in T2, 75% in T3, 51% in T4. Five-year survival in NO was 80% and 22% in N+ cases, with a statictically significant difference (p < 0.05). Five-year survival was 71% in stage I, 83% in stage II, and 54% in stage IV. Five-year survival in low and intermediate grade was 100%, whereas that in high grade was 43%. The 21 patients undergoing modified neck dissection has a 5-year survival of 52%. In 20 patients undergoing postoperative radiotherapy, 4 died of local recurrence. In 31 patients not undergoing chemotherapy, 6 died of distant metastasis. These results emphasize the necessity of radiotherapy and chemotherapy after surgical treatment for head and neck mucoepidermoid carcinoma.     

Internal jugular vein preservation in neck dissection for pN1-N2c oral and oropharyngeal carcinoma

PURPOSE: The aim of this study is to evaluate risk factors of neck recurrence in patients with pN1-N2 neck stage, submitted to a modified radical neck dissection with preservation of the internal jugular vein. MATERIALS AND METHODS: We reviewed the medical records of 72 patients with squamous cell carcinoma of the oral cavity (43 cases) and oropharynx (29 cases). The clinical stage of the neck was N1 in 23 cases and N2a-c in 49. RESULTS: Neck recurrences occurred in 6 cases at the side in which the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .391), T stage (P = .999), N stage (P = .203), adjuvant radiotherapy (P = .999), number of positive lymph nodes (P = .180), lymph nodes size (P = .429), and extracapsular spread (P = .400). CONCLUSIONS: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase on the risk of neck recurrence.     

颞浅血管为蒂的帽状腱膜瓣修复头颈肿瘤术后缺损

OBJECTIVE: To evaluate the advantage and applications of pedicled galeal flap in head and neck region. METHODS: A consecutive series of 17 patients underwent surgical reconstruction with pedicled galeal flaps after head and neck tumor resection. The defects included nasopharynx, skull base, maxilla, orbital base, oropharynx and oral cavity and the size ranged from 5 cm x 5 cm to 10 cm x 10 cm. The technique for using this flap was described and application was illustrated with 3 case reports. RESULTS: Complete success of galeal flaps for the reconstruction of head and neck defects was achieved in 13 of the 17 cases (76.5%) and partial necrosis was observed in the remaining 4 cases (23.4%). Immediate wound complications occurred in four cases, which resolved spontaneously. Four delayed complications were observed in 4 of 9 survival cases that included trismus (3) and alopecia (1). CONCLUSION: Galeal flap is a thin, pliable and well vascularised reconstruction tissue and is highly reliable. The donor site morbidity is minor. We have found the flap to be useful in the reconstruction of a variety of defects in head and neck, especially in skull base, orbital base, nasopharynx and oropharynx.     

Ethmoid sinus cancer: results of treatment with surgery and combined therapy

OBJECTIVE: Ethmoid sinus cancer is a rare paranasal sinus malignancy. Its characteristics include a low incidence rate, a great variety of histopathological types and multiple treatment modalities. Currently, there remains no definite consensus regarding its optimal management. The aim of this study was to examine the outcome of a population of Asian patients with advanced ethmoid sinus cancers that had been treated with surgery plus combined therapy. MATERIAL AND METHODS: Between January 1989 and December 2002 inclusive, 19 newly diagnosed patients with ethmoid sinus cancers who had undergone surgical intervention were enrolled, T4 being the principal carcinoma stage (68.4%). All participating cases proved to be node-negative and no evidence of any distant metastasis was detected at the time of diagnosis. The major treatment modality was surgery plus postoperative radiotherapy. All but 2 of the 13 patients with T4 cancer underwent craniofacial resection with pericranial flap reconstruction. RESULTS: The estimated overall and disease-free survival rates 3 years post-treatment were 49.4% and 26.3%, respectively. Local tumor recurrence was more common than regional recurrence and/or distant metastasis. A total of 5/15 T3-T4 patients (33%) developed a neck metastasis, 3 of whom also suffered a distant metastasis. There was no postoperative mortality for the cases treated with craniofacial resection. CONCLUSIONS: Ethmoid sinus cancer typically demonstrates a propensity for late diagnosis and poor prognosis. This study confirms that craniofacial resection plus combined associated therapy is the optimal approach for the effective management of extensive ethmoid sinus tumors and is associated with an acceptable morbidity rate. More aggressive disease management featuring prophylactic concurrent chemoradiotherapy including neck or elective neck dissection plus chemotherapy should be considered for T3-T4 patients as opposed to T1-T2 patients.