胸大肌肌皮瓣在鼻咽癌放疗后颈部挽救性手术中的应用

Application of pectoralis major myocutaneous flap in repair of postoperative skin defects in nasopharyngeal carcinoma patients with residual or recurrent cervical metastasis after radiotherapy

目的总结胸大肌肌皮瓣在修复鼻咽癌放疗后颈部转移灶残留或复发根治术后缺损中的应用。方法回顾性分析27例鼻咽癌颈部转移灶残留或复发的病人,行根治性颈清扫术,对颈部皮肤缺损用胸大肌肌皮瓣修复。结果1例病人术后3 h死亡,26例病人均一期修复成功。1例术后发生乳糜漏,3例远端吻合口处有感染,5例肌皮瓣远端部分坏死,8例延迟愈合。3年生存率为52.4%。结论鼻咽癌放疗后颈部转移灶残留或复发的挽救性手术应选择根治性颈清扫术;胸大肌肌皮瓣血供丰富,易成活,可取瓣面积大,能满足修复术后缺损的需要。

Objective To sururnarize the experience of application of pectoralis major myocutaneous flap （PMMF） in repair of skin defects in nasopharyngeal carcinoma （NPC） patients with residual or recurrent cervical metastasis after radiotherapy. Methods Clinical data of 27 NPC patients with residual or recurrent cervical metastasis after radiotherapy were analyzed retrospectively. Their skin defects after radical neck dissection （RND） were repaired with PMMF. Results Of all cases, 1 case died of heart failure 3 hours after operation, 1 case had chyle spillage, infection occured in 3 cases, the distal edge of PMMF partially necrotized in 5 case, and 8 case were delayed to heal. Flaps of 26 patients were alive. The 3-year survival rate was 52.4%. Conclusion RND should be selected for NPC patients who have residual or recurrent cervical metastasis after radical radiotherapy. With sufficient tissue for repair, good blood supply and high survival rate, the PMMF can be used to repair the salvage surgery defect for NPC patients.