颞肌瓣在晚期复发性鼻咽癌挽救性手术中的应用

The application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma

目的总结颞肌瓣在晚期复发性鼻咽癌(recurrent nasopharyngeal carcinoma, rNPC)挽救性手术中的应用情况, 为晚期rNPC广泛颅底缺损的修复提供参考方案。方法回顾性分析2018年11月至2021年6月复旦大学附属眼耳鼻喉科医院鼻科收治的晚期rNPC术后使用颞肌瓣修复的患者54例, 其中男42例, 女12例, 年龄29~71岁;rT3患者36例, rT4患者18例。总结颞肌瓣修复术的手术方法, 记录患者的一般情况、生存时间和术后并发症, 探讨颞肌瓣修复术的优缺点。结果使用颞肌瓣可完全覆盖鼻咽和颅底缺损区域, 不需要额外使用其他自体修复材料。随访时间2~28个月, 颞肌瓣成活率为98.1%(53/54), 患者1年总体生存率为84.5%, 1年无进展生存率为49.0%, 未出现面神经损伤的病例。3例(3/54, 5.6%)患者颞肌瓣远端的颅骨骨膜出现坏死且需要手术干预, 4例(4/54, 7.4%)患者因后鼻孔严重狭窄或后鼻孔闭锁需行后鼻孔成形术, 11例(11/54, 20.4%)患者出现张口受限、咀嚼无力、吞咽困难等进食困难症状。结论颞肌瓣修复术是晚期rNPC术后一种可选的修复方式。颞肌瓣成活率高, 覆盖范围广, 但术者应了解并减少并发症的发生。

Objective To summarize the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma(rNPC),and to provide guidance for the repair of extensive skull base defects in salvage rNPC.Methods A total of 54 patients with the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced rNPC were retrospectively analyzed,including 42 males and 12 females,aging from 29 to 71 years.There were 36 patients with rT3 and 18 patients with rT4.The surgical methods of temporalis muscle flap repair were summarized.The general situation,survival time and postoperative complications of patients were recorded,and the advantages and disadvantages of temporalis muscle flap were discussed.Results The temporal muscle flap could completely cover the defect area of nasopharynx and skull base,without the need for other autologous repair materials.The follow-up period was 2 to 28 months.The survival rate of temporalis flap was 98.1%(53/54).The 1-year overall survival rate was 84.5%while 1-year progression-free survival rate was 49.0%.None of the patients had facial nerve injury.Three patients(5.6%)had necrosis of the cranial membrane required surgical intervention and four patients(7.4%)required a chonoplasty due to severe chonostril stenosis or chonostril atresia.Eleven cases(20.4%)had mouth opening restriction,chewing weakness,dysphagia and other eating difficulties.Conclusions Temporalis muscle flap is an alternative flap for the salvage nasopharyngectomy for advanced rNPC.Temporal muscle flap shows high survival rate and wide coverage,but the surgeon should apprehend the possible complications and reduce the occurrence of them.