股前外侧皮瓣卷状皮管在晚期下咽癌术后环周缺损中的应用

Coiled tube of femoral anterolateral flap for repair of circumferential defect after operation of advanced hypopharyngeal carcinoma

目的探讨股前外侧皮瓣卷状皮管在晚期下咽癌术后环周缺损中的临床应用价值。方法回顾性分析2016年1月至2022年4月福建医科大学附属第二医院收治的42例晚期下咽癌患者的临床资料,男41例,女1例,年龄33~82岁,所有患者均行手术治疗,全喉+全下咽切除20例,全喉+全下咽+部分舌根切除8例,全喉+全下咽+颈段食管切除9例,全喉+全下咽+部分舌根+颈段食管切除5例。肿瘤切除术后遗留的下咽环形缺损均行股前外侧皮瓣卷状皮管一期修复,观察术后皮瓣愈合状况、伤口愈合情况、吞咽功能状态。随访肿瘤复发情况及生存状况。结果下咽缺损的长度为7~18 cm,切取的皮瓣大小为6 cm×9.5 cm~10 cm×20 cm。41例皮瓣成活,1例皮瓣出现坏死,皮瓣成活率为97.6%。40例皮瓣血管蒂吻合一条动脉、一条静脉,2例吻合一条动脉、两条静脉血管。术后5例出现颈部伤口感染,2例出现咽瘘。术后3个月复查,31例患者可进普食,9例进半流质饮食,2例进流质饮食。随访6~65个月,14例(33.3%)患者术后出现复发转移,原发部位复发4例(9.5%),颈部淋巴结复发6例(14.3%),远处转移4例(9.5%)。全组病例1年总生存率为79.4%,3年总生存率为60.5%。结论股前外侧皮瓣卷状皮管是一种修复晚期下咽癌术后环周缺损的理想皮瓣。

Objective To investigate the clinical application value of coiled tube of femoral anterolateral flap in the repair of circumferential defect after resection of advanced hypopharyngeal carcinoma.Methods Clinical data of 42 patients with advanced hypopharyngeal cancer admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to April 2022 were retrospectively analyzed,including 41 males and 1 female,aged from 33 to 82 years old.All patients received surgical treatment,including total laryngectomy plus total laryngopharyngectomy in 20 cases,total laryngectomy,total laryngopharyngectomy and resection of partial tongue base in 8 cases,total laryngectomy,total laryngopharyngectomy and resection of cervical esophagus in 9 cases,total laryngectomy,total laryngopharyngectomy,and resection of partial tongue base and cervical esophagus in 5 cases.The postoperative circumferential defects were repaired with the coil tube of anterolateral femoral skin flap in phaseⅠ,and the healing status of the flap,wound healing and swallowing function were observed.All cases were followed up.Results The lengths of the hypopharyngeal defects were 7-18 cm and the sizes of the harvested flaps were 6 cm×9.5 cm-10 cm×20 cm.Flaps survived in 41 cases,flap necrosis occurred in one case,and the survival rate of flaps was 97.6%.One artery and one vein were anastomosed in 40 cases,and one artery and two veins were anastomosed in 2 cases.Postoperative cervical wound infection occurred in 5 cases,and pharyngeal fistula occurred in 2 cases.Three months of follow-up after surgery,31 cases had normal diet,9 cases presented with semi-liquid diet and 2 cases with liquid diet.Following up for 6-65 months,recurrence and metastasis occurred in 14 patients(33.3%),including primary site recurrence in 4 cases(9.5%),cervical lymph node recurrence in 6 cases(14.3%),and distant metastasis in 4 cases(9.5%).The 1-year and 3-year overall survival rates were respectively 79.4%and 60.5%.Conclusion Coiled tube of femoral anterolateral flap is an ideal skin flap for repair of circumferential defects after resection of advanced hypopharyngeal carcinoma.