论文部分内容阅读
目的探讨劈裂式双岛胸大肌皮瓣在复发性口腔癌切除术后口内及颈部缺损修复中的应用价值。方法 2013年9月-2014年9月,收治6例复发性口腔癌患者。男5例,女1例;年龄45~62岁,平均54.7岁。舌癌术后复发4例,下颌牙龈癌及口底癌术后复发各1例。所有患者均为原位局部复发且复发间隔为8~14个月,无肺、肝等远处转移。术中彻底切除复发病灶后,遗留口内缺损4.0 cm×2.5 cm~6.5 cm×3.5 cm,颈部缺损5.5 cm×3.5 cm~7.5 cm×5.0 cm。切取大小为14.0 cm×3.5 cm~17.0 cm×5.5 cm的胸大肌皮瓣,自第3~4肋水平顺胸大肌肌纤维方向劈开至距离胸肩峰血管束约2 cm处,形成具有独立双皮岛的胸大肌皮瓣,其中远端皮岛修复口内缺损,近端皮岛修复颈部缺损。胸部供区直接拉拢缝合。结果术后1例出现颈部血肿,1例颈部感染,经对症处理后愈合;6例胸大肌皮瓣共12个皮岛均成活,切口均Ⅰ期愈合。患者术后均获随访,随访时间6~18个月,平均11个月。1例术后8个月死于肺部转移,余5例随访期间未见复发和远处转移。所有患者口内皮瓣形态良好,语音、吞咽功能恢复满意,颈部外形丰满,运动自如,颌下及颈部无瘘管形成。结论劈裂式胸大肌皮瓣能同时修复口内黏膜和颈部皮肤缺损,在复发性口腔癌根治术后缺损修复中具有应用价值。
Objective To investigate the value of splitting dual island pectoralis major myocutaneous flap in repairing intraoral and neck defects after resection of recurrent oral cancer. Methods From September 2013 to September 2014, 6 patients with recurrent oral cancer were treated. 5 males and 1 females; aged 45 to 62 years, an average of 54.7 years old. Four cases of tongue cancer recurrence, one case of mandibular gingiva cancer and one case of mouth cancer after operation. All patients were in situ local recurrence and recurrence interval of 8 to 14 months, no lung, liver and other distant metastasis. After complete removal of the recurrent lesion, the residual intraoral defect was 4.0 cm × 2.5 cm to 6.5 cm × 3.5 cm and the neck defect was 5.5 cm × 3.5 cm to 7.5 cm × 5.0 cm. Pectoralis major myocutaneous flap size of 14.0 cm × 3.5 cm to 17.0 cm × 5.5 cm was excised and split from the third to the fourth ribs along the muscle fibers of the pectoralis major to about 2 cm from the thoracolumbar vascular bundle, The pectoralis major myocutaneous flap of the independent double island, in which the distal island repair the mouth defect, the proximal island repair the neck defect. Chest for the area directly draw suture. Results One case had neck hematoma, one case had neck infection and healed after symptomatic treatment. Six cases of pectoralis major myocutaneous flap survived in all 12 cases and the incisions healed in the first stage. Patients were followed up after surgery, follow-up time of 6 to 18 months, an average of 11 months. One patient died of pulmonary metastasis 8 months after operation, and no recurrence and distant metastasis were observed in the remaining 5 patients. All patients with good shape of the oral flap, voice, swallowing satisfactory functional recovery, full neck shape, freedom of movement, submandibular and neck fistula formation. Conclusion The splitting pectoralis major myocutaneous flap can repair the mucosa and neck skin defects in the mouth at the same time, which has the value of application in the repair of the defect after radical operation of radical oral cancer.