颏下岛状皮瓣在保留喉功能的下咽癌手术中应用

Application of the submental island flap in hypopharyngeal carcinoma reserved laryngeal function surgery

目的探讨颏下岛状皮瓣在保留喉功能的下咽癌手术中的应用。方法回顾分析30例梨状窝癌行保留喉功能下咽肿瘤切除颏下岛状皮瓣修复的综合治疗的临床资料。结果30例患者行手术患者,利用颏下岛状皮瓣在保留喉功能行下咽癌切除术中缺损进行修复,术后颏下皮瓣均成活,其中4例皮瓣术后局部瘀血部分坏死,皮瓣延迟愈合;无1例咽漏发生;全部患者恢复经口饮食时间为术后34±11d;全部患者拔气管导管时间为术后93±21d。30例患者中,单纯手术5例,术后放疗7例,放疗+化疗18例。患者随访时间10~78个月,失访3例。本组病例术后生存曲线,2、3、5年生存率分别为75.3%、50.8%、43.7%;局部复发伴淋巴结转移8例;肺转移癌6例;食管癌4例;无瘤生存者16例;带瘤生存者7例;死亡4例。结论颏下岛状皮瓣修复下咽肿瘤切除后的缺损,具有皮肤组织量较大,血供确切,抗感染能力强,制作相对简单等诸多优点,适合梨状窝癌半喉侵犯行喉功能保留肿瘤切除术,严格把握适应证,提高患者生活质量。

Objective To explore the effective application of the submental island flap in hypopharyngeal carcinoma reserved laryngeal function surgery.Methods A retrospective study of clinical data of 30 cases with hypopharyngeal carcinoma applicated with submental island flap reserved laryngeal function surgery were retrospective studied.Results Those 30 cases of the hypopharyngeal carcinoma were treated by tumors resection reserved laryngeal function and repaired with submental island flap repairment in the same time.7 cases were treated with radiotherapy alonely and 18cases were treated with radiotherapy and chemotherapy postoperatively.Those follow-up results were recorded.Of 30 cases of the hypopharyngeal carcinoma,all the submental flaps survived postoperatively,including 4 cases delayed survived because of the partial vascular blockage resulted in partial necrosis of those flaps.No pharyngeal leakage occurred.The average time of oral intake resumed was 34+/-11 days postoperatively.The average time of tracheal catheter extraction was 93+/-21 days after surgery.The 2-,3-and 5-year survival rates were 75.3%,50.8%and 43.7%,respectively.Local recurrence with lymph node metastasis in 8 cases,lung metastasis in 6 cases,esophageal cancer in 4 cases.?There were 16 cases of survivors without tumor,7 cases of survivors with tumor and and 3 cases of death.Conclusion The submental island flap has many advantages in repairing the defect of hypopharyngeal tumor resection,such as large amount of skin tissue,rich blood transport,strong anti-infection ability,and the skin incision of the donor site closed directly in most cases.