对侧血管蒂颏瓣修复喉咽恶性肿瘤切除后缺损的研究

Repairment of the hypopharyngeal defect with submental flap pedicled at the unaffected side during surgery for hypopharyngeal carcinoma

目的探讨在颈部增强CT指引下,制作根蒂位于肿瘤主体对侧的颏下穿支皮瓣(对侧颏瓣),同期修复喉咽恶性肿瘤术后缺损的可行性。方法回顾2021年1月~2022年9月首都医科大学附属北京同仁医院耳鼻咽喉头颈外科治疗的15例喉咽恶性肿瘤病例,病变分期为T2~4N0~2M0。术前依据患者颈部增强CT预判颏瓣回流静脉。主要手术方法:预制根蒂位于肿瘤主体对侧的颏瓣,大小为(15~20)cm×(6~7)cm,肿瘤切除后,以颏瓣修复咽喉缺损。15例患者中11例鳞状细胞癌行保喉手术,4例扩大全喉切除术。结果术前依据颈部增强CT观察颏瓣回流静脉:9例回流至颈内静脉,6例回流至颈外静脉,均与手术中颏瓣实际回流情况相符合。15例颏瓣均成活,术后1例感染,保喉者均可持续堵管,发音满意。15例均拔除鼻饲;随访1~21月,无肿瘤复发转移,1年生存率为100%。结论依据颈部增强CT可较准确预判颏瓣回流静脉。采用根蒂位于肿瘤主体对侧的颏瓣修复喉咽恶性肿瘤切除术后缺损,适用于患侧有明显淋巴结转移的病例,在确保彻底清扫病变侧颈淋巴组织的同时,提高颏瓣修复的成功率。

OBJECTIVE To investigate the feasibility and effect of a submental flap(pedicled at the unaffected side)in repairment of the postoperative defect of hypopharyngeal carcinoma through CT prediction.METHODS We reviewed 15cases of laryngopharyngeal malignancies with lesion stages of T2-4N0-2M0 treated in the Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,from January 2021 to September 2022.Preoperative enhanced thin-slice computed tomography of the neck was performed to predict the submental flap reflux vein.The submental flap pedicled at the unaffected side with size of(15-20)cm×(6-7)cm was prefabricated during the operation firstly,and then neck lymph node dissection was taken.The submental flap was pulled to the affected side to repair the defect after the radical resection of the hypopharyngeal tumor.Eleven patients undertook laryngeal preserved surgery and four patients undertook total laryngotomy.RESULTS Intraoperative examination confirmed that among the 15 submental flaps,nine had venous drainage into the internal jugular vein and six had venous drainage into the external jugular vein.These findings were consistent with the preoperative computed tomography findings.Primary healing after surgery was achieved in 14 cases,and no flap necrosis occurred.All 11 laryngeal preserved patients could breath fluently through nose and decannulation was achieved 3 months after operation.Nasal feeding tube was taken out within 1 month in 14 patients.After 3 to 21 months of follow-up,no recurrence occurred.CONCLUSION The reflux vein of the submental flap pedicled at the unaffected side can be predicted accurately according to the enhanced CT of the neck.It is a simple and reliable flap for repairment of the defect after resection of the hypopharyngeal carcinoma with obvious lymphatic metastasis on the affected side.