宽蒂胸大肌皮瓣修复头颈部肿瘤术后缺损39例临床分析

The Clinical Analysis of Wide Pedicled Pectoralis Major Flap in Head and Neck Tumor Resection Defects in 39 Cases

目的通过对应用宽蒂胸大肌皮瓣修复头颈部肿瘤术后缺损的病例进行临床观察及分析,以期望在临床工作中对提高胸大肌皮瓣成活率有所借鉴。方法 2010年3月至2011年8月尼泊尔B、P柯伊拉腊肿瘤医院耳鼻喉-头颈外科对39例头颈部肿瘤术后缺损患者采用宽蒂部胸大肌皮瓣行一期手术修复。男28例,女11例,年龄30~83岁;其中下颌骨鳞状细胞癌11例,颊黏膜鳞状细胞癌9例,口底鳞状细胞癌13例,舌磷癌6例。结果术后38例胸大肌皮瓣完全成活,1例胸大肌皮瓣部分成活。结论采用宽蒂部胸大肌皮瓣进行头颈部肿瘤术后缺损的修复,能有效地避免胸大肌瓣变异回流静脉的损伤,并对胸大肌皮瓣血管蒂的扭转、撕断起到了很好的预防作用,对提高胸大肌皮瓣的成活率有一定的参考价值。

Objective To compare the effectiveness of using width of the pedicle of pectoralis major flap to repair the tissue loss after head and neck cancer surgery,and expect to get some references and good ideas to improve the survival rate of pectoralis major flap in the clinical work.Methods From March,2010 to August,2011,B.P.Koirala Memorial Cancer Hospital in Nepal Otolaryngology-Head and Neck Surgery,39 cases of tissue loss after head and neck surgery underwent one-stage surgical repairs with wide pedicle of pectoralis major muscle flap,28 males and 11 females,aged from 30 to 83 years old.Among them,11 cases of mandibular squamous cell carcinoma,9 cases of squamous cell carcinoma of buccal mucosa,13 cases of floor of mouth squamous cell carcinoma,6 cases tongue squamous cell carcinoma.Results 38 cases of pectoralis major flaps survived completely,1 case of pectoralis major flap partly survived.Conclusion Using the width of the pedicle of pectoralis major muscle flap to repair the tissue loss after head and neck cancer surgery can effectively avoid the damage to the variants veins of the pectoralis major flap,and have effective prevention of reverse and tear-off of the pedicle of pectoralis major flap,and has certain reference values as to improve the survival rate of pectoralis major flap.