同侧鼻唇沟穿支皮瓣一期修复鼻前庭鳞状细胞癌术后缺损

The perforator flap of ipsilateral nasolabial sulcus used to repair the defect after the eradication of nasal vestibular squamous cell carcinoma

目的探讨鼻前庭鳞状细胞癌单纯手术切除治疗的可行性, 以及同侧鼻唇沟穿支皮瓣修复术后缺损的疗效。方法分析2017年10月至2019年9月就诊于复旦大学附属眼耳鼻喉科医院眼耳鼻整形外科的8例鼻前庭鳞状细胞癌患者的临床资料, 其中男性6例, 女性2例, 年龄38~75岁。明确诊断后尽快进行病灶完全切除, 同时利用同侧鼻唇沟穿支皮瓣进行即时修复。术后不行进一步辅助治疗。术后分别对肿瘤复发、患者外观、供区瘢痕、通气及感觉功能等进行评估。采用描述性方法进行分析。结果 8例患者中肿瘤分期T1期2例, T2期6例, 经32~45个月的随访, 所有病例在随访期内无复发。所有皮瓣愈合良好, 其中1例近端翻折嵌入鼻翼外脚缺损处出现直径2 mm左右坏死, 经换药10 d后愈合;另1例早期皮瓣颜色暗黑, 提示血液回流不畅, 及时处理5 d后好转。4例(50%)发生针垫样畸形, 即局部环形隆起, 6个月后逐渐消退。4例(50%)前鼻孔形态有所改变, 但均无通气障碍, 患者未要求再次修复。术后外观评级为"很满意"及"满意", 供区瘢痕不明显。皮瓣感觉于3个月后与周边组织没有差别。结论单纯手术切除T1-2期鼻前庭鳞状细胞癌是可行的治疗方法;同侧鼻唇沟穿支皮瓣一期修复术后缺损是较好的重建方法之一。

Objective To investigate the feasibility of only surgical resection for nasal vestibular squamous cell carcinoma and the efficacy of perforator flap of ipsilateral nasolabial sulcus in repairing postoperative defects.Methods The clinical data of 8 cases with squamous cell carcinoma of the nasal vestibule who admitted to Department of Facial Plastic and Reconstructive Surgery,Eye&ENT Hospital,Fudan University were analyzed,including 6 males and 2 females,aged from 38 to 75 years.The tumor of the nasal vestibule was eradicated in time after making definite diagnosis of lesions,then the perforators flap of the ipsilateral nasolabial sulcus was used for repairment,without performing further chemotherapy or radiotherapy after surgery.The tumor recurrence,facial appearance,nostril form,donor area scar,nasal ventilation function,and cutaneous sensation were evaluated after surgery.Descriptive analysis was used in this research.Results There were 2 cases of stage T1 and 6 cases of stage T2 in 8 cases.After 32 to 45 months of following-up,no recurrence accurred and all the flaps survived well.However,there was about 2 mm necrosis of the transplanted flap in the lateral foot of the alar in one case,which was healed well by carrying out wound care after 10 d.And the dark color flap was occurred in another case,showing the flap′s backflow trouble,yet it was improved with addressing timely during 5 d postoperation.Pincusion-like deformity of the transplanted flap occurred in 4 cases(50%),which subsided gradually after 6 months.The morphology of the anterior nostril was altered in 4 cases(50%),but there was no ventilation trouble and no need for addressment in any case.The postoperative facial appearance was rated as excellentor good with hidden scar in the donor site,and the sensation of the transplanted flaps was indistinct from the surrounding tissue after 3 months.Conclusions Surgical resection of nasal vestibular squamous cell carcinoma with tumor stage T1-2 is a feasible treatment.And it is the one of the best reconstructive methods of the perforator flap of the ipsilateral nasolabial sulcus to repair the deformities after the surgery.