论文部分内容阅读
目的探讨晚期扁桃体癌切除术后缺损修复与功能重建的组织瓣供区选择。方法 2000年10月-2010年2月收治13例晚期扁桃体癌患者。男11例,女2例;年龄39～67岁,平均53.6岁。高分化鳞状细胞癌5例,中分化鳞状细胞癌8例。按国际抗癌联盟(UICC)1997年口咽癌的分期标准:T1N1M0 1例,T2N1M0 2例,T2N2M0 2例,T3N1M0 3例,T3N2M0 2例,T4N1M0 2例,T4N2M0 1例。病程1～8个月,平均4.3个月。肿瘤侵及鼻咽侧壁1例、下咽侧壁3例、会厌1例、软腭4例、舌根部3例。肿瘤浸润范围2 cm×2 cm～12 cm×6 cm。患者均采取手术加术后补充放疗的综合治疗措施。经颈-颌-扁桃体联合入路切除肿瘤后,5例采用带蒂胸大肌皮瓣、5例采用游离前臂皮瓣、3例采用游离股前外侧皮瓣一期修复。结果术后病理报告示颈淋巴结转移10例;补充放疗后8个月～2年局部复发2例,颈部淋巴结转移3例。术后1例带蒂胸大肌皮瓣修复术后第5天出现颈部感染,1例游离前臂皮瓣修复术后12 h出现血管危象,均经对症处理后治愈;其余组织瓣均顺利成活,切口Ⅰ期愈合。1例股前外侧皮瓣供区切口裂开,二期缝合。患者均获随访,随访时间1～6年,平均3.6年。5例带蒂胸大肌皮瓣修复者,术后均有不同程度吞咽梗阻感及闭塞性鼻音,言语清晰度较差。8例游离皮瓣修复者术后外观、吞咽及发声功能较满意,供区无功能障碍。患者术后咬关系均恢复正常,面部外形和功能基本正常。按直接计算法,3年生存率为60.0%(6/10),5年生存率为37.5%(3/8)。结论对晚期扁桃体癌术后缺损的修复应首选游离前臂皮瓣及股前外侧皮瓣,但对于组织需要量大和术前放疗失败的患者,宜选用带蒂胸大肌皮瓣修复。
Objective To investigate the selection of tissue donor sites for defect repair and functional reconstruction after resection of advanced tonsil cancer. Methods From October 2000 to February 2010, 13 patients with advanced tonsillar cancer were treated. 11 males and 2 females; aged 39 to 67 years old, with an average of 53.6 years old. Highly differentiated squamous cell carcinoma in 5 cases, moderately differentiated squamous cell carcinoma in 8 cases. According to the 1997 International Union Against Cancer (UICC) staging criteria of oropharyngeal cancer: T1N1M0 1 cases, T2N1M0 2 cases, T2N2M0 2 cases, T3N1M0 3 cases, T3N2M0 2 cases, T4N1M0 2 cases, T4N2M0 1 case. Duration of 1 to 8 months, an average of 4.3 months. Tumor invasion and nasopharyngeal wall in 1 case, hypopharyngeal wall in 3 cases, epiglottis in 1 case, 4 cases of soft palate, 3 cases of tongue base. Tumor infiltration range 2 cm × 2 cm ~ 12 cm × 6 cm. Patients were treated with surgery plus postoperative radiotherapy comprehensive treatment. After tumor removal by neck-jaw-tonsil approach, 5 cases were treated with pedicel pectoralis major flap, 5 cases with free forearm flap and 3 cases with free anterolateral skin flap. Results Postoperative pathology showed 10 cases of cervical lymph node metastasis; 2 cases local recurrence 8 months to 2 years after radiotherapy, 3 cases of cervical lymph node metastasis. One case of pedunculated pectoralis major myocutaneous flap had neck infection on the fifth day after operation, and one case of vascular injury at 12 hours after the repair of the free forearm flap were cured after symptomatic treatment. The rest of the flap was well Survival, incision healed. One case of anterior lateral flap for incision cleft incision, two suture. Patients were followed up for 1 to 6 years, an average of 3.6 years. 5 cases of pedunculated pectoralis major flap repair, postoperative have varying degrees of swallowing obstruction and nasal obstruction, speech articulation is poor. 8 cases of free flap repair postoperative appearance, swallowing and vocal function is more satisfactory for the area without dysfunction. Patient postoperative bite relationship returned to normal, facial shape and function of the basic normal. According to the direct calculation method, the 3-year survival rate was 60.0% (6/10) and the 5-year survival rate was 37.5% (3/8). Conclusions The free forearm flap and anterolateral femoral flap should be the first choice for the repair of postoperative tonsil cancer. However, for the patients with large tissue requirement and preoperative radiotherapy failure, the pedicle pectoralis major muscle flap should be selected for repair.