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目的:探讨中晚期舌根癌手术缺损的重建方法。方法:以30例中晚期舌根鳞状细胞癌患者为研究对象,T2N1M04例,T3N1M07例,T3N2M010例,T4N1M04例,T4N2M05例。原发灶手术方法:舌骨咽侧切开入路12例,下颌骨正中切开入路18例。全部病例均于术后4~6周放疗。结果:带蒂胸大肌肌皮瓣修复25例,所有肌皮瓣均成活,其中1例口内皮瓣与周围组织部分分离,1例肌皮瓣局部组织坏死,均经局部换药后愈合。游离股前外侧肌皮瓣修复5例,有1例肌皮瓣局部组织坏死,经口清除坏死组织至新鲜创面,二期愈合。18例保喉患者全部拔管。3年生存率为68%,局部控制率为87%。结论:胸大肌肌皮瓣和股前外侧肌皮瓣是舌根修复可选用的供区组织。最有效和可靠的重建方法应首选胸大肌肌皮瓣,股前外侧肌游离皮瓣供区隐蔽,也是一种有效的修复手段,但需要熟练的显微手术技术。
Objective: To explore the reconstructive method of middle and late tongue base cancer surgery defect. Methods: Twenty cases of tongue squamous cell carcinoma of middle and late stage were studied. Among them, there were 04 cases of T2N1M, 7 cases of T3N1M0, 10 cases of T3N2M0, T4N1M04 cases and T4N2M05 cases. Primary surgery: 12 cases of hyoid pharyngeal incision and 18 cases of middle mandibular incision. All cases were 4 to 6 weeks after radiotherapy. Results: Pedunculated pectoralis major myocutaneous flap was repaired in 25 cases. All myocutaneous flaps survived. One case of the flap was isolated from the surrounding tissue, and one case of myocutaneous flap was necrotic, which was healed after local dressing change. Five cases were repaired with free anterolateral myocutaneous flap, one case was local tissue necrosis of myocutaneous flap, the necrotic tissue was removed by mouth to the fresh wound and healed in the second period. 18 cases of patients with all throat extubation. The 3-year survival rate was 68% and the local control rate was 87%. Conclusion: The pectoralis major myocutaneous flap and anterolateral myocutaneous flap are the alternative tissues for tongue base repair. The most effective and reliable method of reconstruction should be the preferred pectoralis major myocutaneous flap, anterolateral free muscle flap for the area hidden, is also an effective means of repair, but requires skilled microsurgery.