游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果

Effect of double-leaf perforator free flap posterolateral calf peroneal artery on reconstruction of oropharyngeal anatomy after ablation of advanced oropharyngeal carcinoma

目的评价应用游离小腿后外侧腓动脉双叶穿支皮瓣移植重建晚期口咽癌术后口咽部解剖结构和功能的临床效果。方法2016年7月~2018年7月,对26例口咽癌根治术患者术中采用小腿后外侧腓动脉双叶穿支游离皮瓣重建口咽部解剖结构,其中舌根部癌12例,咽侧壁癌5例,软腭癌9例。术中切取的双叶穿支皮瓣修复口咽部组织缺损的面积范围是72.5~40.5 cm^2。重建方式:9例重建软腭-翼腭缺损,5例重建翼颌-舌外侧缘缺损,12例重建舌根-咽侧缺损。术后6月的门诊随访和12月、24月、36月的跟踪随访,评价患者开口度、吞咽功能、语音功能恢复和患者的生存状况,并通过鼻咽镜检查评价重建后的咽部结构和腭咽闭合功能,采用中文版FACT-H&N(4)量表计算患者术后生存质量。结果26例患者游离皮瓣均成活。术后6月,患者口咽功能基本恢复正常和解剖结构恢复良好;量表调查显示:患者在身体状况、社会/家庭状况、情感状况、功能状况、核心量表总分、头颈模块和量表总分均获得较高的术后生存质量量值,与术前相比较,有明显的统计学意义(P<0.05)。结论小腿后外侧游离腓动脉双叶穿支皮瓣穿支血管恒定,设计灵活,组织量丰富,修复方式和幅度多变,是晚期口咽癌术后重建口咽部解剖结构和功能较为理想的穿支皮瓣,且有效提高了患者的生存质量。

Objective To evaluate the effect of using free double-leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma.Methods Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited,including 12 with carcinoma in the tongue base,5 in the latenral pharyngeal wall and 9 in the soft palate.Between July,2016 and July,2018,the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps.The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm^2.Reconstruction was performed for oropharyngeal defects in the soft palate,pterygopalate,parapharyngeal,pterygo-mandibular,and tongue base tissues.The patients'outcomes including mouth opening,functions of deglutition,linguistic function,restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated,and their quality of life was assessed using FACT-H&N scale(Chinese Edition).Results All the 26 patients with transplantation of the free flaps survived.Six months after the operation,the oropharyngeal function and anatomical structure of the patients were basically restored.The questionnaire survey showed that the patients'physical,social/family,emotional and functional conditions,the total score of the core scale,items scores for the head and neck,and the total score of the scale all improved significantly after the operation compared with those before the operation(P<0.05).Conclusion The free peroneal artery bilobate perforator flap in the posterolateral crus,which seldom has anatomical variations of the blood vessels,allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges.The application of this flap,which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function,can improve the quality of life of patients following operations for advanced oropharyngeal cancer.