吻合血管前臂皮瓣游离移植修复下咽癌术后缺损疗效.docVIP

吻合血管前臂皮瓣游离移植修复下咽癌术后缺损疗效[摘要] 目的 分析吻合血管的前臂皮瓣游离移植修复喉癌术后缺损的临床疗效。 方法 选择明确诊断的下咽癌患者16例，所有患者行下咽癌联合根治术加吻合血管的前臂皮瓣游离移植修复术后缺损，随访观察并分析手术疗效和喉功能恢复情况。 结果 术后15块组织皮瓣完全存活，1例部分坏死。13例受区伤口Ⅰ期愈合、3例出现局部并发症延期愈合，15例供区创面Ⅰ期愈合、1例因伤口裂开延期愈合。所有患者术后外观基本恢复正常，15例吞咽和发音功能均良好，可进行清楚语言交流，1例患者经2个月进食锻炼后回复吞咽功能。10例患者无瘤生存，2例死于肿瘤局部复发，4例患者死于咽淋巴环转移。 结论 吻合血管的前臂皮瓣游离移植是一种有效修复下咽癌术后缺损的方法，重建后的发音、吞咽功能恢复理想。 [关键词] 前臂皮瓣游离移植；修复；下咽癌；缺损 [中图分类号] R473.73 [文献标识码] A [文章编号] 1674-4721（2012）07（a）-0024-02 The efficacy of vascularized free radical forearm flap for hypopharyngeal carcinoma postoperative defect LUO Ruihua DAI Liyuan CUI Meng QI Jingxing Department of Head and Neck Surgery, Henan Tumor Hospital, Zhengzhou 450003, China [Abstract] Objective To analyze the efficacy of vascularized free radical forearm flap for hypopharyngeal carcinoma postoperative defect. Methods Sixteen patients with hypopharyngeal carcinoma were selected. The hypopharyngeal joint radical mastectomy and vascularized free radical forearm flap repaired postoperative defect were performed on all patients. The efficacy and function of throat were followed up. Results Fifteen free radial forearm flaps survived completely and 1 patial necrosis. The accept flap wound of 13 cases were phaseⅠhealing and 3 cases delayed healing. The supply flap wound of 15 cases were phaseⅠhealing and 1 cases delayed healing. The function of swallow and voice of 15 patients recovered from surgery and 1 patient swallow function recovered after 2 months. Ten patients without tumor recurrence were survival, 2 patients with local recurrence and 4 patients died of lymph node metastatic. Conclusions Vascularized free radical forearm flap is a useful treatment to repair hypopharyngeal carcinoma postoperative defect，and recovery of swallowing function and vocal function after reconstruction is good. [Key words] Free radical forearm flap; Repair; Hypopharyngeal carcinoma; Defect 下咽癌以根治性外科治疗为主，主张在彻底切除病变的前提下，尽量保留其功能，以提高患者的生存质量，但术后常常遗留多创面、多容积、多种组织的缺损，严重影响患者的外观和功能[1]，如何有效修补下咽癌术后