腹直肌-腹膜瓣修复舌缺损的临床研究

Reconstruction of the tongue with rectus abdominis musculoperitoneal flap

目的探讨腹直肌-腹膜瓣修复舌缺损的临床效果。方法2003年9月至2004年4月,5例舌癌患者接受了舌癌联合根治术同期腹直肌-腹膜瓣修复术。腹直肌-腹膜瓣包括腹直肌、腹直肌后鞘、腹膜、肋间神经及腹壁下动静脉。术中将肋间神经与舌下神经降支吻合。结果全部腹直肌-腹膜瓣成活。术后随访至今,无严重并发症,再造舌外形及活动度满意,语音、吞咽功能接近正常。术后2个月组织学检查证实腹膜上皮化。结论腹直肌-腹膜瓣行半舌再造的初步临床效果满意。

Objective To investigate the outcome of surgical reconstruction of the tongue after hemiglossectomy with reinnervated rectus abdominis musculoperitoneal flaps in the treatment of tongue cancer. Methods Five patients underwent immediate reconstruction of the tongue and oral floor defects with rectus abdominis musculoperitoneal flaps after resection of squamous cell carcinoma of tongue. The rectus abdominis musculoperitoneal flap consists of the rectus muscle, posterior rectus sheath, peritoneum, the 10 th, 11th, 12th intercostal nerves and the vascular pedicle that includes the deep inferior epigastric artery and veins. During the operation a reinnervated rectus abdominis musculoperitoneal free flap, in which the intercostal nerves were anastomosed to the descending branch of hypoglossal nerve, was grafted to remaining tongue stump. Results All patients recovered unevenfully from surgery, with no immediate postoperative complications. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium 8 weeks after surgery. The average follow-up period was 10 months. During the follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. The swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet. Conclusions Reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method. Long-term follow-up is needed for reaching some final conclusions.