游离前臂皮瓣在局部晚期下咽癌喉功能保留手术中的初步应用

Use of Radial forearm free flaps for laryngeal preservation operations in patients with local advanced hypopharyngeal carcinoma

目的探讨游离前臂皮瓣在保留喉功能的下咽癌手术中的应用及其疗效。方法从2008年10月至2011年12月,对5例T3、T4期下咽癌患者行半喉半咽切除术,用游离前臂皮瓣修复喉以及喉咽缺损,根据缺损区大小和部位,切取相应皮瓣并塑形后,恢复喉和喉咽的正常解剖形态和生理功能。术后辅以放疗,平均剂量65Gy。结果 5例皮瓣全部成活,术后未出现严重并发症,全部病例恢复正常进食与发音功能,其中3例拔除金属导管,另有2例带管。随访3年以上,最长者随访6年,局部未见肿瘤复发。结论游离前臂皮瓣用于下咽癌切除后的下咽、喉缺损修复,具有可靠、易存活、厚度适合、易于塑形的优点,有利于下咽癌手术的喉功能保留。

Objective To explore the application and efficacy of using free radial forearm flap in cases with hypopharyngeal carcinoma which were performed hemi-pharyngolaryngetomy and laryngeal preservation procedures. Methods Retrospective re-view of the archives of 5 patients who underwent resections of extended squamous cell carcinoma of hypopharynx from October 2008 to December 2011. A total of 3 patients had T3 lesions and 2 patients had T4 lesions in original location. All patients were performed with hemi-pharynolaryngectomy and one-stage pharyngolaryngeal reconstruction functionally according to the shapes and cites of tissue defect. All patients received radiotherapy additionally （65Gy）. Results 5 radial forearm free flaps survived well and no major complications occurred. The swallowing and speech function of these pationts recovered well. Three patients were decannulated and two patients dressed metal tracheal stent. After following up for 3 years to 6 years ,no local recurrences were found. in these patients. Conclusion The radial forearm free flaps are can be used to reconstruct pharyngolaryngeal defects in la-ryngeal function preservation operations because of the characters of pliability,high surviving rates,moderate depth,easily plastic potential capability.