胸大肌肌皮瓣修复晚期口咽侧壁肿瘤手术缺损

One-stage reconstruction with the pectoralis major myocutaneous flap for the pharyngectomy

对18例晚期口咽侧壁肿瘤患者的术后缺损，用胸大肌肌皮瓣修复。取瓣面积为15cm×10cm～3cm×3cm；3例发生部分坏死，4例行预防性气管切开；术后外形及口咽功能恢复均满意。术后3年和5年生存率分别为61．5％和40．0％。皮瓣的愈合与本前放疗及术中操作等因素有关。认为晚期口咽侧壁肿瘤术后缺损应首选胸大肌肌皮瓣作一期修复，以提高患者生存质量，延长其生命。

18 patients with the advanced oropharyngeal cancer from October 1983 to July 1992 were retrospectively studied in our hospital. The blood supply of the pectoralis major myocutaneous flap(PMMF). PMMF came mainly from the pectoral branch of the acromiothoracic artery.The flap area ranged from 15 cm × 10 cm to 3 cm × 3cm. 3 cases had partial necrosis and 4 cases received prophylactic tracheotomy. The cosmetic and functional restoration was satisfactory in most of the patients. The factors which affected the wound healing were also discussed. The 3 year and 5 year survival rates were 61. 5% and 40%, respectlvely. This paper revealed that the PMMF was the first choice for the defect of the pharyngectomy.