胸大肌肌皮瓣在侵犯下咽晚期头颈鳞癌手术切除术后缺损修复中的应用

目的 探讨不同情况下应用胸大肌肌皮瓣(PMF)修复下咽颈食管区域重要和复合缺损的方法和可行性。 方法 采用PMF单独或联合其他修复方法,结合对修复方法的改良,采用不同方式修复晚期和复发性下咽癌和喉癌侵犯下咽颈食管区域手术切除术后下咽颈食管巨大和复合性缺损59例,缺损类型包括下咽颈食管部分缺损、下咽颈食管环周缺损以及下咽颈食管缺损合并颈前软组织巨大复合缺损。 结果 完成单纯PMF覆盖法26例,椎前筋膜游离植皮加PMF覆盖4例,PMF覆盖加颈前表面游离植皮2例,PMF覆盖下咽加胸三角皮瓣(DPF)修复颈前缺损2例,单纯PMF皮管16例,PMF皮管加肩胸皮瓣表面覆盖4例,胃上提加PMF覆盖3例,双岛瓦合PMF 2例。术后20例出现了不同程度并发症,除1例院内死亡外,其余均经妥善处理治愈,恢复吞咽功能。 结论 PMF适合各种情况的下咽颈食管缺损修复,特别是在颈部同时伴有巨大软组织复合缺损时,这种方法更具优越性。

Reconstruction of hypopharyngeal defects after ablation of advanced head and neck squamous carcinoma invol-ving hypophaynx with pectoralis major myocutaneous flap

Objective To explore the eligibility of using pectoralis major myocutaneous flap (PMF)to reconstruct ma-jor and complex defects in the hypopharngeal and cervical esophageal regions.Methods PMF with or without combi-nations of other reconstructive tissue flaps were used with some modifications to surgical techniques.Major or complex defects were caused in 59 patients after en bloc removal of advanced and recurrent hypopharyngeal and laryngeal canc-ers,which included partial and circumferential hypopharyngeal defects,and circumferential pharyngeal defects with complex soft tissue defects in the anterior neck.Results Single patch-on PMF was used in 26 cases,patch-on PMF with anterior vertebral skin graft in 4 cases,patch-on PMF with anterior neck skin graft in 2 cases,patch-on PMF with deltopectoral flap in 2 cases,tubed PMF in 16 cases,tubed PMF with deltopectoral flap in 4 cases,gastric pull-up plus PMF in 4 cases,and double-paddled PMF in 2 cases.Post-operative complications were encountered in 20 cases,which were managed properly.All patients were healed and restored their swallowing function,except one patient who died in hospital.Conclusion PMF is suitable for reconstruction of nearly all kinds of defects in hypopharyngeal and cervical e-sophageal regions,especially for those with complex soft tissue defects in the anterior neck.