胸大肌皮瓣在老年人口腔口咽晚期癌手术中的应用

The application of pectoralis major myocutaneous flap in surgery of advanced cancer in oral and oral-pharyngeal region in the aged

目的:探讨胸大肌皮瓣在老年人口腔口咽晚期癌挽救手术中的临床应用价值.方法:自2000年7月至2003年10月,我院为31例60岁以上口腔口咽晚期癌患者实施手术,并对遗留的大块组织缺损采用胸大肌岛状肌皮瓣一期整复.结果:29例患者安全度过围手术期,1例在术后第2天死于呼吸衰竭,另一例在术后第2天死于消化道应激性溃疡导致的失血性休克.29例胸大肌肌皮瓣中27例完全成活,1例肌皮瓣皮肤坏死而肌肉成活,1例远端部分皮肤坏死.无其它严重并发症出现.25例获随访2个月至3年,3例于术后半年至1年内肿瘤复发死亡,5例于1～3年间死亡.其余存活病例胸大肌皮瓣形态大体较好,语音和吞咽无明显障碍.结论:胸大肌肌皮瓣组织量大,血供丰富,操作相对简单,安全性高,非常适合应用在老年人口腔口咽晚期癌手术中整复大型组织缺损,并有助于提高手术治疗效果和患者的生活质量.

Objective: To explore the clinical value of using pectoralis major myocutaneous island flap in surgery of advanced cancer in oral and oral-pharyngeal region in the aged. Methods:From July 2000 to October 2003, 31patients over 60 year-old with advanced cancer in oral and oral-pharyngeal region were performed for surgery, and pectoralis major myocutaneous island flaps were applied for immediate reconstruction of the large defects. Results:29 patients tided over perioperation time 1 patient died of respiratory failure at 2th day post-operation, and another died of hypovolemic shock caused by stress ulcer. 27 out of 29 flaps survived well skin necrosis occurred in 1 flap and showed partial necrosis. 25 patients were followed up for 2 months to 3 years, and 3 cases were lost. 5 patients died of recurrence of cancer within 0.5-1 year and 6 cases died within 1-3 years. The face appearance of the survivors recovered well, speaking as well as swallowing functions showed no remarkable damage. Conclusions:Due to the excellent blood supply, abundant tissue and good security, the pectoralis major myocutaneous flap is really fit to the immediate reconstruction of the large defects in surgery of advanced cancer in oral and oral-pharyngeal region in the old. It can help to improve the effectiveness of surgery and the quality of life.