颏下动脉带蒂皮瓣在下咽修复中的应用

Applieation of submental artery flap in reconstruction of hypopharynx

目的:探讨颏下动脉带蒂皮瓣在下咽恶性肿瘤切除术后修复中的应用。方法:梨状窝鳞状细胞癌患者5例,均为男性,年龄49~70岁,平均年龄61.2岁。其中4例行选择性颈淋巴结清扫术、完整切除肿瘤并保留部分喉功能,将设计好的颏下动脉带蒂皮瓣向下拉至下咽缺损部位进行修复。另1例为梨状窝癌手术后吻合口狭窄的患者,裂开狭窄部位后,利用颏下动脉带蒂皮瓣进行修复。皮瓣大小从7 cm×3 cm^8 cm×5 cm。结果:5例患者手术均获成功,颏下皮瓣成活,供区切口Ⅰ期愈合,术后7~36 d顺利拔除气管套管及胃管。随访10~28个月,患者咽部皮瓣生长良好,言语及吞咽功能满意,颈部瘢痕隐蔽。结论:颏下动脉带蒂皮瓣血供好,易取材,成活率高,是修复下咽恶性肿瘤切除术后缺损的有用材料。

Objective：To evaluate the clinical application of submental artery island flap in reconstruction of hypopharynx following hypopharyngectomy. Methods：Five patients with pyriform sinus squamous cell carcinoma were enrolled. All of patients were male,ages ranged from 49 years to 70 years with a mean age of 61.2 years. Among them,4 patients underwent selective neck dissection along with the radical excision of the primary lesion,and the laryngeal function was partly reserved. The submental artery island flaps were then used for reconstruction of hypopharyngeal defects in these 4 patients. Another patient was anastomosis orifice stricture of postoperative pyriform sinus carcinoma,and the reconstruction using submental artery island flap was performed following fissure of the stricture. The size of the skin paddle ranged from 7 cm × 3 cm to 8 cm × 5 cm. Results：The surgical procedures were successful,and the submental artery island flaps were survived in all cases. Donor site incision healed by first intention. Trachea cannula and gastric tube were pulled-out 7~36 days after operation. The follow-up period ranged from 10 to 28 months. The statuses of the flaps were good with satisfactory speech and swallowing function in all the patients. Neck scar contracture was well hidden. Conclusion：The submental artery island flap is useful in hypopharyngeal reconstruction after resection of hypopharyngeal carcinoma,because of its abundant blood supply,convenient donor site,and high survival rate.