颈阔肌皮瓣在下咽癌术后缺损修复中的应用

Platysma myocutaneous flaps in reconstruction of defects caused by hypopharyngeal cancer resection

目的:探讨颈阔肌皮瓣修复下咽癌术后组织缺损的方法及可行性。方法:应用颈阔肌皮瓣对12例下咽癌术后软组织缺损的患者进行修复。所有患者术前均行2次诱导化疗,并进行了保留喉功能的下咽癌手术和颈部淋巴结清扫术。结果:12例患者皮瓣全部存活。术后3周所有患者经口进食,无咽瘘,均有咽部异物感,但无吞咽困难。其中3例术后呛咳明显,训练后好转。术后均接受放疗,皮瓣无继发坏死。所有患者均保留了喉功能,除1例外其余都已拔管。结论:术前对下咽癌患者进行诱导化疗可有效缩小病灶。颈阔肌皮瓣血运丰富,抗感染力较强,成活率高,是修复下咽组织缺损行之有效的方法,手术方法简便,值得推广。

Objective：To study the method and feasibility in reconstruction of platysma myocutaneous flap of defects caused by hypopharyngeal cancer resection.Method：Twelve cases underwent reconstruction with the platysma myocutaneous flap of hypopharyngeal soft defect were investigated.All cases received 2 times preoperative induction chemotherapy followed by hypopharyngeal cancer resection with laryngeal function preservation and the neck lymph node dissection.Platysma myocutaneous flap was used to repair the hypopharyngeal soft tissue defect.Result：All the flaps survived.Three weeks after surgery,all patients can eat without pharyngeal fistula and dysphagia,but pharyngeal foreign body sensation.Three cases of cough after surgery,improved after training.After postoperative radiotherapy,flap survived without secondary necrosis.Laryngeal function of all cases was retained,and only one case with cannula maintained.Conclusion：Preoperative induction program can effectively reduce the lesion.The placenta myocutaneous flap has rich blood supply,strong anti-infectivity.It is an effective method to repair the hypopharyngeal tissue defect with the placenta myocutaneous flap.