颈部严重放射损伤的临床治疗

Clinical treatment of severe neck radiotherapy injury

目的 总结了 2 2例颈部严重放射损伤的临床治疗经验。方法 本组共 2 2例 ,男 13例 ,女 9例 ,年龄最小 32岁 ,最大 6 8岁。主要为乳腺癌、鼻咽癌等颈部、锁骨上转移而以6 0 Co r射线、深层X射线或加速器电子线放疗后造成的损伤。局部累积照射剂量为 6 5～ 130Gy。采用姑息性清创 ,部分切除变性的胸锁乳突肌、有锁骨骨髓炎或骨坏死者一并切除 ,然后以轴型皮瓣或肌皮瓣移转修复。结果 移植的皮瓣、肌皮瓣全部成活 2 2例 ,溃疡甲级愈合 2 0例 (90 9% ) ,乙级愈合 2例(9 1% ) ;颈部活动功能基本恢复 ,呼吸困难及吞咽受阻症状消失或改善。结论 颈部严重放射损伤常引起严重并发症。应用整形外科原则 ,选用血循环丰富的轴型皮瓣或肌皮瓣移植修复 ,能有效地改善血液循环、促进创面愈合。同时能取得改善颈部活动功能和良好外形的效果。

Objective To summarize our experience in the treatment of 22 cases of severe neck radiotherapy injury. Methods Of the 22 cases, 13 were male and 9 female. The youngest was 32 and the oldest was 68 years old. Their injuries were mainly resulted from radiotherapy for cervical and supraclavicular metastasis of breast or nasopharyngeal cancer by 60Co|γ rays, deep x|rays or superficial accelerator electron. Their local accumulation dose was 65Gy～130Gy. Palliative debridement was performed with partial excision of the degenerative sternocleidomastoid muscle and resection of the clavicle for osteomyelitis and necrosis. And then the defects were repaired with an axial skin flap or musculocutaneous flap. Results All the skin flaps and musculocutaneous flaps grafted on the wound of the 22 cases were survived (100%). The grade A healing was found in 20 cases of ulcer (90^9%) and grade B healing in 2 cases (9^1%). Neck activity was almost recovered with dyspnoea and dysphagia eliminated or improved. Conclusion Severe neck radiotherapy injury often results in complications and should repaired by transferring an axial skin flap or a musculocutaneous flap with good blood circulation selected in accordance with the principles of plastic surgery, which can effectively improve blood circulation and promote wound healing. ;