胸骨舌骨肌筋膜瓣在下咽癌术后修复中的应用

Reconstruction of the hypopharynx with a fascial flap of the strap muscles in hypopharyngeal cancer

目的：探讨胸骨舌骨肌筋膜瓣在下咽癌术后修复中的应用。方法：1987年6月至1997年6月收治9例下咽癌患者，根据2002年UICC分期标准，Ⅱ期1例，Ⅲ期4例，Ⅳ期4例。咽侧手术入路切除肿瘤，术后根据需要分别制作胸骨舌骨肌筋膜瓣、胸骨舌骨肌肌瓣、胸骨舌骨肌肌筋膜瓣等行组织缺损修复和咽喉功能重建，2例联合裂层皮片修复。术后均予以辅助放射治疗，剂量60～80Gy。结果：所有修复组织成活，术后伤口感染1例，经冲洗换药后延迟愈合。9例患者均拔除了气管套管，保留了全部喉功能。术后12～35d恢复经口进食，平均16．3d；发生咽瘘2例，经换药、冲洗、加压包扎等处理后愈合。无咽食管狭窄发生。3年生存率66．7％（6／9），5年生存率44．4％（4／9）。结论：胸骨舌骨肌及筋膜瓣可以修复下咽前壁、舌根、外侧壁，是一种简捷有效的修复方式。

Objective： To investigate the methods with a faseial flap of the strap muscles in reconstruction for hypopharyngeal carcinoma. Method： Nine patients with hypopharyngeal cancer （stage Ⅱ, 1; stage Ⅲ, 4; and stage Ⅳ, 4; according to the UICC 2002 staging criteria） were surgically treated from June 1987 to June 1997. lateral pharynx approaches were chosen based on the condition of process to perform the ablation of tumors, and fascial flap/muscular flap/muscular-fascial flap of the strap muscles were used to repair the defects and reconstruct the functions of larynx and pharynx. Adjutant radiation therapy of 60-80 Gy was performed on all cases. Results： All repair materials used were alive. One case suffered from postoperative wound infection and healed after constant rinsing and dressing changes. Two cases suffered from pharyngeal fistula and healed after dressing changes, rinsing and pressurizing. All patients＇ laryngeal functions were preserved. All patients recovered diet within 12 to 35 days, with a mean time of 16.3 days. No pharyngosterosis and esophagostenosis happened. The 3- and 5-year survival rates were 66.7% （6/9） and 44.4% （4/9）, respectively. Conclusion： It is an available way to repair the defect of the hypopharyngeal paries anterior and the base of tongue with fascial flap/muscularflap/muscular-fascial flap of the strap muscles.